Outcomes of Intraoperative Venoarterial Extracorporeal Membrane Oxygenation Versus Cardiopulmonary Bypass During Lung Transplantation
Outcomes of Intraoperative Venoarterial Extracorporeal Membrane Oxygenation Versus Cardiopulmonary Bypass During Lung Transplantation
复制标题
DOI：
10.1016/j.athoracsur.2014.06.072
复制
发表时间：
2014-12-01
影响因子：
4.6
通讯作者：
Pilewski, Joseph M.
中科院分区：
文献类型：
--
作者：
Bermudez, Christian A.;Shiose, Akira;Pilewski, Joseph M.
背景肺移植术中使用体外循环（CPB）与肺功能障碍和出血并发症的发生率增加有关。最近，体外膜肺氧合（ECMO）已成为一种有效的替代支持方法，自2012年3月以来一直是我们的首选支持方法。我们比较了这两种支持方法的早期和中期结果。2007年7月至2013年4月期间，271例连续患者接受了使用CPB（n = 222）或ECMO（n = 49）的肺移植。我们回顾性分析了肺移植期间需要CPB或ECMO的患者的结局。CPB组和ECMO组具有相似的人口统计学和手术特征;然而，ECMO组的平均肺分配评分更高（73 vs 52，p < 0.001）。在CPB组中，更多患者需要重新插管（35.6% vs 20.4%，p = 0.04）或临时气管切开术（44.6% vs 28.6%，p = 0.05）。CPB组患者需要透析的肾衰竭发生率高于ECMO组（22.1% vs 8.2%，p = 0.028）。两组之间需要术后循环支持（p = 0.83）或围手术期红细胞输注（p = 0.64）的重度PGD无差异。30天（5% CPB vs 4.1% ECMO）或6个月死亡率（14.4% CPB vs 14.3% ECMO）无差异。在肺移植中使用ECMO是安全的，根据我们的经验，与CPB相比，ECMO与肺和肾并发症的发生率降低有关。体外膜肺氧合已成为我们肺移植术中支持的首选方法。(C)2014年由胸外科医师协会
Background. The intraoperative use of cardiopulmonary bypass (CPB) in lung transplantation has been associated with increased rates of pulmonary dysfunction and bleeding complications. More recently, extracorporeal membrane oxygenation (ECMO) has emerged as a valid alternative method of support and has been our preferred method of support since March 2012. We compared early and midterm outcomes of these 2 support methods.Methods. Between July 2007 and April 2013, 271 consecutive patients underwent lung transplant using CPB (n = 222) or ECMO (n = 49). We retrospectively reviewed the outcomes of these patients requiring CPB or ECMO during lung transplant.Results. The CPB and ECMO groups had comparable demographic and operative characteristics; however, the ECMO group had higher mean lung allocation scores (73 vs 52, p < 0.001). In the CPB group, more patients required reintubation (35.6% vs 20.4%, p = 0.04) or temporary tracheostomy (44.6% vs 28.6%, p = 0.05). Patients in the CPB group had a higher rate of renal failure requiring dialysis than the ECMO group (22.1% vs 8.2 %, p = 0.028). There were no differences in severe PGD requiring postoperative circulatory support (p = 0.83) or the need for perioperative red blood cell transfusions (p = 0.64) between the groups. No differences in 30-day (5% CPB vs 4.1% ECMO) or 6-month mortality (14.4% CPB vs 14.3% ECMO) were noted.Conclusions. The use of ECMO in lung transplant is safe and in our experience was associated with decreased rates of pulmonary and renal complications, as compared with CPB. Extracorporeal membrane oxygenation has become our preferred method of intraoperative support during lung transplantation. (C) 2014 by The Society of Thoracic Surgeons