Outcomes of intraoperative venoarterial extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation

Christian A. Bermudez, Akira Shiose, Stephen A. Esper, Norihisa Shigemura, Jonathan D'Cunha, Jay K. Bhama, Thomas J. Richards, Peter Arlia, Maria M. Crespo, Joseph M. Pilewski

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Abstract

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.

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.

Original languageEnglish
Pages (from-to)1936-1943
Number of pages8
JournalAnnals of Thoracic Surgery
Volume98
Issue number6
DOIs
Publication statusPublished - Jan 1 2014
Externally publishedYes

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Extracorporeal Membrane Oxygenation
Lung Transplantation
Cardiopulmonary Bypass
Lung
Transplants
Prostaglandins D
Erythrocyte Transfusion
Tracheostomy
Renal Insufficiency
Dialysis
Demography
Hemorrhage
Kidney

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes of intraoperative venoarterial extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation. / Bermudez, Christian A.; Shiose, Akira; Esper, Stephen A.; Shigemura, Norihisa; D'Cunha, Jonathan; Bhama, Jay K.; Richards, Thomas J.; Arlia, Peter; Crespo, Maria M.; Pilewski, Joseph M.

In: Annals of Thoracic Surgery, Vol. 98, No. 6, 01.01.2014, p. 1936-1943.

Research output: Contribution to journalArticle

Bermudez, CA, Shiose, A, Esper, SA, Shigemura, N, D'Cunha, J, Bhama, JK, Richards, TJ, Arlia, P, Crespo, MM & Pilewski, JM 2014, 'Outcomes of intraoperative venoarterial extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation', Annals of Thoracic Surgery, vol. 98, no. 6, pp. 1936-1943. https://doi.org/10.1016/j.athoracsur.2014.06.072
Bermudez, Christian A. ; Shiose, Akira ; Esper, Stephen A. ; Shigemura, Norihisa ; D'Cunha, Jonathan ; Bhama, Jay K. ; Richards, Thomas J. ; Arlia, Peter ; Crespo, Maria M. ; Pilewski, Joseph M. / Outcomes of intraoperative venoarterial extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation. In: Annals of Thoracic Surgery. 2014 ; Vol. 98, No. 6. pp. 1936-1943.
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title = "Outcomes of intraoperative venoarterial extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation",
abstract = "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.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.",
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AU - Bermudez, Christian A.

AU - Shiose, Akira

AU - Esper, Stephen A.

AU - Shigemura, Norihisa

AU - D'Cunha, Jonathan

AU - Bhama, Jay K.

AU - Richards, Thomas J.

AU - Arlia, Peter

AU - Crespo, Maria M.

AU - Pilewski, Joseph M.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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.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.

AB - 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.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.

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