Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Ann Thorac Surg. 2011 Oct;92(4):1226-31; discussion 1231-2. doi: 10.1016/j.athoracsur.2011.04.122. Epub 2011 Aug 26.
Extracorporeal membrane oxygenation (ECMO) is used occasionally as a bridge to lung transplantation. The impact on mid-term survival is unknown. We analyzed outcomes after lung transplant over a 19-year period in patients who received ECMO support.
From March 1991 to October 2010, 1,305 lung transplants were performed at our institution. Seventeen patients (1.3%) were supported with ECMO before lung transplant. Diagnoses included retransplantation (n = 6), pulmonary fibrosis (n = 6), cystic fibrosis (n = 4), and chronic obstructive pulmonary disease (n = 1). Fifteen patients underwent double lung transplant, one patient had single left lung transplant and one patient had a heart-lung transplant. Venovenous and venoarterial ECMO were implanted in eight and nine cases, respectively. Median duration of support was 3.2 days (range, 1 to 49 days). Mean patient follow-up was 2.3 years.
Thirty-day, 1-year, and 3-year survivals were 81%, 74%, and 65%, respectively, for the supported patients and 93%, 78%, and 62% in the control group (p = 0.56). Two-year survival was not affected by ECMO type, with survival of five out of nine patients supported by venoarterial ECMO vs seven out of eight patients supported by venovenous ECMO (p = 0.17). At 1- year follow-up, allograft function for the ECMO-supported patients did not differ from the control group (forced expiratory volume in one second, 2.35 L vs 2.09 L, p = 0.39) (forced vital capacity, 3.06 L vs 2.71 L, p = 0.34).
Extracorporeal membrane oxygenation as a bridge to lung transplantation is associated with higher perioperative mortality but acceptable mid-term survival in carefully selected patients. Late allograft function did not differ in patients who received ECMO support before lung transplant from those who did not receive ECMO.
体外膜肺氧合(ECMO)偶尔被用作肺移植的桥梁。其对中期生存率的影响尚不清楚。我们分析了在我们机构进行的 19 年期间接受 ECMO 支持的肺移植患者的中期生存率。
1991 年 3 月至 2010 年 10 月,我院共进行了 1305 例肺移植。17 例(1.3%)患者在肺移植前接受 ECMO 支持。诊断包括再次移植(n=6)、肺纤维化(n=6)、囊性纤维化(n=4)和慢性阻塞性肺疾病(n=1)。15 例患者接受双肺移植,1 例患者接受单左肺移植,1 例患者接受心肺移植。分别植入静脉-静脉和静脉-动脉 ECMO 8 例和 9 例。支持时间中位数为 3.2 天(范围,1 至 49 天)。平均患者随访 2.3 年。
支持组患者的 30 天、1 年和 3 年生存率分别为 81%、74%和 65%,对照组患者分别为 93%、78%和 62%(p=0.56)。2 年生存率不受 ECMO 类型的影响,9 例接受静脉-动脉 ECMO 支持的患者中有 5 例存活,8 例接受静脉-静脉 ECMO 支持的患者中有 7 例存活(p=0.17)。在 1 年随访时,ECMO 支持组患者的移植物功能与对照组患者无差异(用力呼气量,2.35L 比 2.09L,p=0.39)(用力肺活量,3.06L 比 2.71L,p=0.34)。
体外膜肺氧合作为肺移植的桥梁,与精心选择的患者围手术期死亡率较高,但中期生存率可接受。接受 ECMO 支持的肺移植患者与未接受 ECMO 支持的患者相比,晚期移植物功能无差异。