Extracorporeal membrane oxygenation after lung transplantation: evolving technique improves outcomes.
BACKGROUND
Severe pulmonary graft failure (PGF) is the most common cause of death within the first 30 days after lung transplantation. Extracorporeal membrane oxygenation (ECMO) may provide lifesaving temporary support; however, its longer-term efficacy is controversial.


METHODS
We reviewed the use of ECMO for severe PGF after lung transplantation, and compared the outcomes between our early (1990 to 1999) and recent (2000 to 2003) experience utilizing improved initiation timing, oxygenator technology, and surgical technique.


RESULTS
Ten transplant recipients from a total of 481 (2.1%) were managed for PGF on ECMO by a multidisciplinary team at The Alfred Hospital. Four single-lung, 3 bilateral single-lung, and 3 heart-lung recipients were supported for a mean of 96 hours (range 14 to 212 hours). In the early group (operation from 1990 to 1999, n = 4) ECMO was initiated 21 days (range 7 to 40 days) after lung transplantation and in the recent group (operation from 2000 to 2003, n = 6) after 0 to 2 days (p = 0.01). Radial-arterial blood gas analysis 12 hours after initiation of ECMO showed significantly better oxygenation in the recent group (341 +/- 90 mm Hg) than in the early group (90 +/- 23 mm Hg, p = 0.03). Four deaths occurred as a result of bleeding (two in each group). In the early group only 1 patient was weaned from ECMO but died. In the recent group 3 were successfully weaned and were discharged from the intensive care unit; of these patients, 2 were discharged from hospital.


CONCLUSIONS
Extracorporeal membrane oxygenation results have improved with advances in oxygenator technology and surgical techniques. The procedure can allow resolution of early PGF after lung transplantation.
Oto
Takahiho
T
Heart and Lung Transplant Unit, The Alfred Hospital, Monash University Medical School, Melbourne, VIC, Australia. takahirooto@aol.com
Rosenfeldt
Franklin
F
Rowland
Michael
M
Pick
Adrian
A
Rabinov
Marc
M
Preovolos
Arthur
A
Snell
Gregory
G
Williams
Trevor
T
Esmore
Donald
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D002315:Cardiopulmonary Bypass; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control / Q000628:therapy; D016041:Heart-Lung Transplantation / Q000706:statistics & numerical data; D006440:Hemofiltration; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016040:Lung Transplantation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D009569:Nitric Oxide / Q000627:therapeutic use; D011175:Positive-Pressure Respiration; D011183:Postoperative Complications / Q000401:mortality; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D009569:Nitric Oxide