The Munich Lung Transplant Group: Intraoperative Extracorporeal Circulation in Lung Transplantation.
BACKGROUND
This retrospective single-center study aimed to analyze transfusion requirements, coagulation parameters, and outcome parameters in patients undergoing lung transplantation (LuTx) with intraoperative extracorporeal circulatory support, comparing cardiopulmonary bypass (CPB), and extracorporeal membrane oxygenation (ECMO).


METHODS
Over a 3-year period, 49 of a total of 188 LuTx recipients were identified being set intraoperatively on either conventional CPB (n = 22) or ECMO (n = 27). Intra- and postoperative transfusion and coagulation factor requirements as well as early outcome parameters were analyzed.


RESULTS
LuTx patients on CPB had significantly higher intraoperative transfusion requirements when compared with ECMO patients, that is, packed red cells (9 units [5-18] vs. 6 units [4-8], p = 0.011), platelets (3.5 units [2-4] vs. 2 units [0-3], p = 0.034), fibrinogen (5 g [4-6] vs. 0 g [0-4], p = 0.013), prothrombin complex concentrate (3 iU [2-5] vs. 0 iU [0-2], p = 0.001), and tranexamic acid (2.5 mg [2-5] vs. 2.0 mg [1-3], p = 0.002). Also, ventilator support requirements (21 days [7-31] vs. 5 days [3-21], p = 0.013) and lengths of ICU stays (36 days [14-62] vs. 15 days [6-44], p = 0.030) were markedly longer in CPB patients. There were no differences in 30-day and 1-year mortality rates.


CONCLUSIONS
These data indicate a perioperative advantage of ECMO usage with low-dose heparinization over conventional CPB for extracorporeal circulatory support during LuTx. Long-term outcome is not affected.
Department of Anesthesiology, Ludwig Maximilian University, Munich, Germany.
Dominik J
DJ
Hoechter
Department of Anesthesiology, Ludwig Maximilian University, Munich, Germany.
Vera
V
von Dossow
Department of General, Visceral, Transplant, Vascular and Thoracic Surgery, University Hospital, Ludwig Maximilian University, Munich, Germany.
Hauke
H
Winter
University of Marburg, Institute of Medical Biometry and Epidemiology, Germany.
Hans-Helge
HH
Müller
Transplantation Center, University Hospital, Ludwig Maximilian University, Munich, Germany.
Bruno
B
Meiser
Department of Internal Medicine V, University Hospital, Ludwig Maximilian University, Munich, Germany.
Claus
C
Neurohr
Department of Internal Medicine V, University Hospital, Ludwig Maximilian University, Munich, Germany.
Juergen
J
Behr
Department of Cardiac Surgery, University Hospital, Ludwig Maximilian University, Munich, Germany.
Sabina
S
Guenther
Department of Cardiac Surgery, University Hospital, Ludwig Maximilian University, Munich, Germany.
Christian
C
Hagl
Transplantation Center, University Hospital, Ludwig Maximilian University, Munich, Germany.
René
R
Schramm
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000401:mortality; D003029:Coagulants / Q000008:administration & dosage; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005858:Germany; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008168:Lung / Q000503:physiopathology / Q000601:surgery*; D008171:Lung Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D003029:Coagulants; D006493:Heparin