Five-year experience with intraoperative extracorporeal membrane oxygenation in lung transplantation: Indications and midterm results.
BACKGROUND
Since April 2010, extracorporeal membrane oxygenation (ECMO) has replaced cardiopulmonary bypass for intraoperative support during lung transplantation at our institution. The aim of this study was to present our 5-year experience with this technique.


METHODS
Records of patients who underwent transplantation between April 2010 and January 2015 were retrospectively reviewed. Patients who underwent transplantation without ECMO formed Group A. Patients in whom the indication for ECMO support was set a priori before the beginning of the operation formed Group B. The remaining patients in whom the indication for ECMO support was set during transplantation formed Group C.


RESULTS
Among 595 patients, 425 (71%) patients (Group A) did not require intraoperative ECMO; the remaining 170 (29%) patients did. Among these patients, 95 (56%) patients formed Group B, and the remaining 75 (44%) patients comprised Group C. Pulmonary fibrosis and pre-operative dilated or hypertrophied right ventricle emerged as risk factors for the indication of non-a priori intraoperative ECMO. Patients in Groups B and C showed a higher pre-operative risk profile and higher prevalence of post-operative complications than patients in Group A. Overall survival at 1 year was 93%, 83%, and 82% and at 4 years was 73%, 68%, and 69% in Groups A, B, and C (p = 0.11). The intraoperative use of ECMO did not emerge as a risk factor for in-hospital mortality or mortality after hospital discharge.


CONCLUSIONS
Intraoperative ECMO filled the gap between pre-operative and post-operative ECMO in lung transplantation. Although complications and in-hospital mortality were higher in patients who received ECMO, survival was similar among patients who underwent transplantation with or without ECMO.
Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
Fabio
F
Ius
Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease Hanover (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany.
Wiebke
W
Sommer
Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
Igor
I
Tudorache
Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
Murat
M
Avsar
Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
Thierry
T
Siemeni
Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
Jawad
J
Salman
Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
Ulrich
U
Molitoris
Department of Anaesthesiology.
Clemens
C
Gras
Department of Anaesthesiology.
Bjoern
B
Juettner
Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
Jakob
J
Puntigam
Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
Joerg
J
Optenhoefel
Department of Respiratory Medicine.
Mark
M
Greer
Department of Paediatrics, Hanover Medical School, Hanover, Germany.
Nicolaus
N
Schwerk
Biomedical Research in End-Stage and Obstructive Lung Disease Hanover (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany; Department of Respiratory Medicine.
Jens
J
Gottlieb
Biomedical Research in End-Stage and Obstructive Lung Disease Hanover (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany; Department of Respiratory Medicine.
Tobias
T
Welte
Biomedical Research in End-Stage and Obstructive Lung Disease Hanover (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany; Department of Respiratory Medicine.
Marius M
MM
Hoeper
Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease Hanover (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany.
Axel
A
Haverich
Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
Christian
C
Kuehn
Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease Hanover (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany. Electronic address: warnecke.gregor@mh-hannover.de.
Gregor
G
Warnecke
D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care / Q000379:methods*; D008171:Lung Diseases / Q000601:surgery*; D016040:Lung Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
a priori intraoperative ECMO; lung transplantation; multivariate analysis; non–a priori intraoperative ECMO; patient and graft survival; risk factors for mortality