title: Comparison of extracorporeal membrane oxygenation versus cardiopulmonary bypass for lung transplantation.
abstract: OBJECTIVE
  This study compared differences in patient outcomes and operative parameters for extracorporeal membrane oxygenation (ECMO) versus cardiopulmonary bypass (CPB) in patients undergoing lung transplants.
  
  
  METHODS
  Between January 1, 2008, and July 13, 2013, 316 patients underwent lung transplants at our institution, 102 requiring intraoperative mechanical cardiopulmonary support (CPB, n=55; ECMO, n=47). We evaluated survival, blood product transfusions, bleeding complications, graft dysfunction, and rejection.
  
  
  RESULTS
  Intraoperatively, the CPB group required more cell saver volume (1123±701 vs 814±826 mL; P=.043), fresh-frozen plasma (3.64±5.0 vs 1.51±3.2 units; P=.014), platelets (1.38±1.6 vs 0.43±1.25 units; P=.001), and cryoprecipitate (4.89±6.3 vs 0.85±2.8 units; P<.001) than the ECMO group. Postoperatively, the CPB group received more platelets (1.09±2.6 vs 0.13±0.39 units; P=.013) and was more likely to have bleeding (15 [27.3%] vs 3 [6.4%]; P=.006) and reoperation (21 [38.2%] vs 7 [14.9%]; P=.009]. The CPB group had higher rates of primary graft dysfunction at 24 and 72 hours (41 [74.5%] vs 23 [48.9%]; P=.008; and 42 [76.4%] vs 26 [56.5%]; P=.034; respectively). There were no differences in 30-day and 1-year survivals.
  
  
  CONCLUSIONS
  Relative to CPB, the ECMO group required fewer transfusions and had less bleeding, fewer reoperations, and less primary graft dysfunction. There were no statistically significant survival differences at 30 days or 1 year.
authors.affiliation: Department of General Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Mauer
authors.initials: M
authors.lastname: Biscotti
authors.affiliation: Department of General Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of General Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Joshua
authors.initials: J
authors.lastname: Sonett
authors.affiliation: Department of General Surgery, Columbia University Medical Center, New York, NY. Electronic address: mb781@cumc.columbia.edu.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bacchetta
mesh_terms: D000328:Adult; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000401:mortality; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality / Q000628:therapy; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009519:New York City; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D055031:Primary Graft Dysfunction / Q000209:etiology / Q000401:mortality / Q000628:therapy; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome