Minqiang Liu, Xiaoshan Li, Bo Xu, Guilong Wang, Zhengfeng Gu, Dong Wei, Jingyu Chen, Qiang Wu, Chunxiao Hu
Department of Anesthesiology, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China.
Department of Lung Transplantation Center, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.
Transplantation. 2021 Apr 1;105(4):867-875. doi: 10.1097/TP.0000000000003290.
Extracorporeal membrane oxygenation (ECMO) is widely used for cardiopulmonary assistance during lung transplantation (LTx). However, the optimal timing for ECMO removal remains controversial. This study aimed to evaluate the risk factors and early prognosis of delayed withdrawal ECMO after LTx.
Two hundred sixty-seven patients who underwent LTx supported by ECMO were included in this study. Based on whether or not ECMO was completely stopped in the operating room, patients were divided into early ECMO withdrawal group (group E, 107 cases) and delayed withdrawal group (group D, 160 cases). Perioperative data of the donors and recipients, including the suspected risk factors for delayed removal of ECMO, postoperative complications, and hospital survival rate, were retrospectively analyzed.
Preoperative New York Heart Association cardiac function for recipients and mechanical ventilation time for donors were independent risk factors for delayed weaning of ECMO in veno-arterial ECMO patients. Compared with group E, the odds of postoperative pulmonary infection, primary graft dysfunction, renal dysfunction, blood transfusion volume, and mechanical ventilation time were significantly higher in group D (all P < 0.05). Delayed withdrawal ECMO was decisive factor for early postoperative death, as the risk of early postoperative death in group D was 1.99 (95% confidence interval, 1.13-3.54) times as that in the group E.
During the period of LTx, New York Heart Association grade III/IV for recipients and mechanical ventilation time ≥5 days for donors are suggestive of delayed veno-arterial ECMO removal, and clinicians should minimize the postoperative bypass time of ECMO when conditions permit.
体外膜肺氧合（ECMO）在肺移植（LTx）期间广泛用于心肺支持。然而，ECMO撤除的最佳时机仍存在争议。本研究旨在评估LTx后延迟撤除ECMO的危险因素及早期预后。
本研究纳入了267例接受ECMO支持的LTx患者。根据ECMO在手术室是否完全停止，将患者分为早期ECMO撤除组（E组，107例）和延迟撤除组（D组，160例）。回顾性分析供体和受体的围手术期数据，包括ECMO延迟撤除的可疑危险因素、术后并发症及医院生存率。
受体术前纽约心脏协会（NYHA）心功能分级及供体机械通气时间是静脉-动脉ECMO患者ECMO延迟撤机的独立危险因素。与E组相比，D组术后肺部感染、原发性移植肺功能障碍、肾功能不全、输血量及机械通气时间的发生率均显著更高（均P<0.05）。延迟撤除ECMO是术后早期死亡的决定性因素，因为D组术后早期死亡风险是E组的1.99倍（95%置信区间，1.13-3.54）。
在LTx期间，受体NYHAⅢ/Ⅳ级及供体机械通气时间≥5天提示静脉-动脉ECMO延迟撤除，临床医生应在条件允许时尽量缩短术后ECMO体外循环时间。
