Intraoperative extracorporeal support during lung transplantation in patients bridged with venovenous extracorporeal membrane oxygenation
Intraoperative extracorporeal support during lung transplantation in patients bridged with venovenous extracorporeal membrane oxygenation
复制标题
DOI：
10.1016/j.healun.2018.07.003
复制
发表时间：
2018-12-01
影响因子：
8.9
通讯作者：
Cypel, Marcelo
中科院分区：
文献类型：
--
作者：
Hashimoto, Kohei;Hoetzenecker, Konrad;Cypel, Marcelo
背景：静脉静脉（VV）体外膜氧合（ECMO）是等待肺移植的呼吸衰竭患者桥接的首选配置。然而，对于这些患者在肺移植过程中的术中体外心肺支持还没有达成共识。方法：回顾VV ECMO桥术后术中体外电路的配置，并将其与临床结果相关联。本回顾性队列研究于2007年至2016年在我校附属医院进行，纳入34例仅通过VV ECMO成功桥接肺移植的患者。术中静脉（VA） ECMO的适应症是血流动力学损害（全身性低血压或平均肺动脉压低于40毫米汞柱）或当这种情况被认为极有可能发生时。结果：桥接的中位持续时间为12 （IQR 7 ~ 19）天。术中3例（8.8%）患者需要体外循环。20例患者（58.8%）继续使用VV ECMO， 11例（32.3%）切换到中心VA ECMO。两种术中ECMO （VV vs VA）在术后ECMO持续时间、因出血重新开胸或肾脏替代治疗方面无显著差异。90天死亡率（0%和9.0%,p = 0.35）和长期生存率（p = 0.59）无显著差异。VA组术中红细胞输注量更高（5[4 ~ 9]比8[6 ~ 13]单位，p = 0.06）。术中使用VA ECMO与使用低流量VV装置桥接和大叶移植相关。结论：在肺移植术中使用现有的VV ECMO桥是可行的，并且对于因血流动力学受损而转为中央VA ECMO的患者提供了相当的结果。(C) 2018国际心肺移植学会。版权所有。
BACKGROUND: Venovenous (VV) extracorporeal membrane oxygenation (ECMO) is the preferred configuration for bridging respiratory failure patients while awaiting lung transplantation. However, there is no consensus on intraoperative extracorporeal cardiopulmonary support during lung transplantation in these patients.METHODS: The configuration of the intraoperative extracorporeal circuit after VV ECMO bridge was reviewed and correlated with clinical outcomes. This retrospective cohort study performed at our university hospital included 34 patients who were successfully bridged solely with VV ECMO to lung transplantation during the period 2007 to 2016. Indications to switch to intraoperative venoarterial (VA) ECMO were hemodynamic compromise (systemic hypotension or mean pulmonary artery pressure >40 mm Hg) or when this scenario was thought to be highly likely.RESULTS: The median duration of bridging was 12 (IQR 7 to 19) days. Intraoperatively, 3 patients (8.8%) required cardiopulmonary bypass. Twenty patients (58.8%) stayed on VV ECMO and 11 (32.3%) were switched to central VA ECMO. Between the 2 types of intraoperative ECMO (VV vs VA), there were no significant differences in post-operative ECMO duration, chest reopening for bleeding, or renal replacement therapy. There was no significant difference in 90-day mortality (0% and 9.0%, p = 0.35) or in long-term survival (p = 0.59). The intraoperative transfusion of red blood cells tended to be higher in the VA group (5 [4 to 9] vs 8 [6 to 13] units, p = 0.06). Use of intraoperative VA ECMO was associated with the use of low-flow VV device bridging and lobar transplantation.CONCLUSIONS: Using the existing VV ECMO bridge intraoperatively during lung transplantation is feasible and provides comparable outcomes to patients converted to central VA ECMO for compromised hemodynamics. (C) 2018 International Society for Heart and Lung Transplantation. All rights reserved.