Narm Kyoung Shik, Lee Seokkee, Suh Jee Won, Kim Anes, Lee Jin Gu, Park Moo Suk, Kim Song Yee, Song Joo Han, Jeong Su Jin, Paik Hyo Chae
Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea.
Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.
Ann Thorac Surg. 2018 Jan;105(1):242-248. doi: 10.1016/j.athoracsur.2017.07.046. Epub 2017 Nov 11.
Extracorporeal membrane oxygenation (ECMO) has been widely used for hemodynamic support during lung transplantation (LTx). We evaluated the risk factors associated with failure of weaning from ECMO in the operating room during LTx.
We retrospectively reviewed 74 consecutive patients who had undergone LTx from March 2013 to February 2016. Patients who underwent single LTx, multiorgan transplantation, and LTx for pulmonary hypertension were excluded. All operations were performed under ECMO support. Clinical data of donor, recipient, and intraoperative parameters were reviewed.
Younger donors (40 ± 11 versus 45 ± 10 years, p = 0.047), donors with shorter mechanical ventilation (125 ± 74 versus 160 ± 80 minutes, p = 0.066) and donors with higher Pao at 100% oxygen (455 ± 87 mm Hg versus 399 ± 88 mm Hg, p = 0.008) were significantly different in the ECMO weaning group than in the weaning failure group. Of the recipients, the number of patients who had preoperative ECMO support were significantly fewer in the successful weaning group than in the weaning failure group (11.9% versus 34.4%, p = 0.061). The operation time was significantly shorter in the weaning group than in the weaning failure group (392 ± 66 versus 435 ± 82 minutes, p = 0.014). In multivariate logistic regression analysis, the independent risk factors for ECMO weaning were donor age (odds ratio 1.101, 95% confidence interval: 1.030 to 1.177, p = 0.005), donor Pao (odds ratio 0.992, 95% confidence interval: 0.984 to 0.999, p = 0.034), and operation time (odds ratio 1.010, 95% confidence interval: 1.000 to 1.019, p = 0.043).
Our results showed that younger donor age, high Pao, and shorter operation time were factors related to successful ECMO weaning in the operating room after LTx.
体外膜肺氧合（ECMO）已广泛用于肺移植（LTx）期间的血流动力学支持。我们评估了LTx手术期间在手术室中与ECMO撤机失败相关的危险因素。
我们回顾性分析了2013年3月至2016年2月期间连续接受LTx的74例患者。排除接受单肺移植、多器官移植以及因肺动脉高压进行肺移植的患者。所有手术均在ECMO支持下进行。回顾了供体、受体的临床资料以及术中参数。
与撤机失败组相比，ECMO撤机组的供体年龄更小（40±11岁对45±10岁，p = 0.047）、机械通气时间更短（125±74分钟对160±80分钟，p = 0.066）以及在100%氧气条件下的动脉血氧分压（Pao）更高（455±87 mmHg对399±88 mmHg，p = 0.008）。在受体中，成功撤机组术前接受ECMO支持的患者数量显著少于撤机失败组（11.9%对34.4%，p = 0.061）。撤机组的手术时间显著短于撤机失败组（392±66分钟对435±82分钟，p = 0.014）。在多因素逻辑回归分析中，ECMO撤机的独立危险因素为供体年龄（比值比1.101，95%置信区间：1.030至1.177，p = 0.005）、供体Pao（比值比0.992，95%置信区间：0.984至0.999，p = 0.034）以及手术时间（比值比1.010，95%置信区间：1.000至1.019，p = 0.043）。
我们的结果表明，供体年龄较小、Pao较高以及手术时间较短是LTx术后手术室中ECMO成功撤机的相关因素。
