Aigner Clemens, Wisser Wilfried, Taghavi Shahrokh, Lang György, Jaksch Peter, Czyzewski Damian, Klepetko Walter
Department of Cardio-Thoracic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Eur J Cardiothorac Surg. 2007 Mar;31(3):468-73; discussion 473-4. doi: 10.1016/j.ejcts.2006.11.049. Epub 2007 Jan 12.
Extracorporeal membrane oxygenation (ECMO) is currently accepted in lung transplantation either to bridge patients to transplantation or to treat postoperatively arising severe primary graft failure. Based on promising initial experiences we have since 2001 implemented ECMO as the standard of intraoperative extracorporeal support in lung transplantation (LuTX) patients with haemodynamic or respiratory instability with the potential to prolong ECMO support into the perioperative period. The aim of this paper is to summarise our total experience with the use of ECMO in LuTX.
We retrospectively reviewed all 306 patients undergoing primary lung transplantation from 1/2001 to 1/2006 with regard to the different forms of ECMO use. Results of all patients requiring ECMO were compared to those without ECMO during the observation period.
ECMO was used in 147 patients in total. Two patients were bridged to transplantation. A total of 130 patients received intraoperative ECMO support. In 51 of these patients ECMO was prolonged into the perioperative period. Five of these patients required ECMO support again in the postoperative period due to graft dysfunction. Contrary cardiopulmonary bypass was used in 27 patients mainly with concomitant cardiac defects. Eleven of these patients needed therapeutic ECMO in the further course. A total of 149 patients without relevant risk factors were transplanted without any intraoperative extracorporeal support. Six of these patients required ECMO support in the postoperative period for treatment of primary graft dysfunction. Overall 3-month, 1-year and 3-year survival rates were 88.6%, 82.1% and 74.63%. The mentioned survival rates were 85.4%, 74.2% and 67.6% in the intraoperative+/-prolonged ECMO group; 93.5%, 91.9% and 86.5% in the no support group and 74.0%, 65.9% and 57.7% in the CPB group.
ECMO is a valuable tool in lung transplantation providing the potential to bridge patients to transplantation, to replace CPB with at least equal results and to overcome severe postoperative complications. Favourable survival rates can be achieved despite the fact that ECMO is used in the more complex patient population undergoing lung transplantation as well as to overcome already established severe complications.
体外膜肺氧合（ECMO）目前在肺移植中被广泛应用，可用于将患者过渡到移植阶段，或治疗术后出现的严重原发性移植肺功能衰竭。基于自2001年以来取得的令人鼓舞的初步经验，我们将ECMO作为肺移植（LuTX）术中体外支持的标准方法，用于血流动力学或呼吸不稳定的患者，并有可能将ECMO支持延长至围手术期。本文旨在总结我们在肺移植中使用ECMO的总体经验。
我们回顾性分析了2001年1月至2006年1月期间接受初次肺移植的306例患者使用ECMO的不同形式。将所有需要ECMO的患者的结果与观察期内未使用ECMO的患者的结果进行比较。
共有147例患者使用了ECMO。2例患者通过ECMO过渡到移植。共有130例患者在术中接受了ECMO支持。其中51例患者的ECMO支持延长至围手术期。这些患者中有5例术后因移植肺功能障碍再次需要ECMO支持。27例主要伴有心脏缺陷的患者使用了体外循环（CPB）。这些患者中有11例在后续过程中需要治疗性ECMO。共有149例无相关危险因素的患者在没有任何术中体外支持的情况下接受了移植。这些患者中有6例术后因原发性移植肺功能障碍需要ECMO支持。总体3个月、1年和3年生存率分别为88.6%、82.1%和74.63%。术中使用ECMO（±延长至围手术期）组的上述生存率分别为85.4%、74.2%和67.6%；无支持组分别为93.5%、91.9%和86.5%；CPB组分别为74.0%、65.9%和57.7%。
ECMO是肺移植中的一种有价值的工具，具有将患者过渡到移植阶段的潜力，能以至少相同的效果替代CPB，并能克服严重的术后并发症。尽管ECMO用于更复杂的肺移植患者群体以及克服已出现的严重并发症，但仍可实现良好的生存率。
