Heart Center of the University of Leipzig, Leipzig, Germany.
Ann Thorac Surg. 2012 Sep;94(3):942-9; author reply 949-50. doi: 10.1016/j.athoracsur.2012.05.006. Epub 2012 Jun 28.
Indications for extracorporeal membrane oxygenation (ECMO) use in lung transplantation are (1) temporary assistance as a bridge to transplantation, (2) stabilization of hemodynamics during transplantation in place of cardiopulmonary bypass, and (3) treatment of severe lung dysfunction and primary graft failure after transplantation. This study compares the survival of lung transplant recipients requiring ECMO support with survival of patients without ECMO.
A retrospective database review was performed for 108 consecutive patients who underwent single-lung or bilateral-lung transplantation at our center between 2002 and 2009.
Of 108 transplant recipients, 27 (25%) required venoarterial ECMO compared with 81 patients who did not. Nine patients required ECMO preoperatively (87±102 hours), and ECMO was continued for 5 patients during the lung transplant operation. Seven additional patients received ECMO during transplantation. Six patients required early (<7 days) and 5 patients delayed (≥7 days) postoperative ECMO for treatment of allograft dysfunction. The subgroup with support showed the most favorable patient discharge rate (66.7%). ECMO support was a significant risk factor for death (p<0.001). Survival was significantly reduced with the use of ECMO: 30-day, 90-day, 1-year, and 5-year survival was 97%, 91%, 83%, and 58% in the patients without ECMO compared with 63%, 44%, 33%, and 21% in those with ECMO, respectively.
Survival after lung transplantation was significantly reduced with ECMO. However, patients who survived the first year showed similar long-term survival as those patients who did not need perioperative ECMO support.
体外膜肺氧合（ECMO）在肺移植中的应用指征包括：（1）作为移植的临时辅助手段，（2）在移植过程中替代心肺旁路以稳定血液动力学，以及（3）治疗移植后严重的肺功能障碍和原发性移植物失功。本研究比较了需要 ECMO 支持的肺移植受者的生存率与未接受 ECMO 治疗的患者的生存率。
对 2002 年至 2009 年期间在我们中心接受单肺或双肺移植的 108 例连续患者进行了回顾性数据库研究。
在 108 例移植受者中，27 例（25%）需要静脉-动脉 ECMO，而 81 例患者不需要。9 例患者在术前需要 ECMO（87±102 小时），5 例患者在肺移植手术期间继续接受 ECMO。另外 7 例患者在移植过程中接受了 ECMO。6 例患者因移植物功能障碍需要早期（<7 天）和 5 例患者需要延迟（≥7 天）术后 ECMO。有支持组的患者出院率最高（66.7%）。ECMO 支持是死亡的显著危险因素（p<0.001）。使用 ECMO 显著降低了生存率：无 ECMO 组的 30 天、90 天、1 年和 5 年生存率分别为 97%、91%、83%和 58%，而有 ECMO 组的 30 天、90 天、1 年和 5 年生存率分别为 63%、44%、33%和 21%。
肺移植后，ECMO 显著降低了生存率。然而，存活超过 1 年的患者与未接受围手术期 ECMO 支持的患者具有相似的长期生存率。
