Programa de Transplante Pulmonar, Hospital Israelita Albert Einstein, Sao Paulo, SP, BR.
Clinics (Sao Paulo). 2020 Apr 30;75:e1698. doi: 10.6061/clinics/2020/e1698. eCollection 2020.
To report initial experience from the use of extracorporeal membrane oxygenation (ECMO) in patients who received lung transplantation.
Retrospective study of a single tertiary center in the Brazilian state of São Paulo, a national reference in lung transplantation, based on the prospective collection of data from electronic medical records. The period analyzed extended from January 2009 (beginning of the program) until December 2018.
A total of 75 lung transplants were performed, with ECMO used in 8 (10.7%) cases. Of the patients, 4 (50%) were female. The mean age was 46.4±14.3 years. The causes of the end-stage lung disease that led to transplantation were pulmonary arterial hypertension in 3 (37.5%) patients, bronchiectasis in 2 (25%) patients, pulmonary fibrosis in 2 (25%) patients, and pulmonary emphysema in 1 (12.5%) patient. In our series, 7 (87.5%) cases were sequential bilateral transplantations. Prioritization was necessary in 4 (50%) patients, and in 1 patient, ECMO was used as a bridge to transplantation. The ECMO route was central in 4 (50%), peripheral venovenous in 2 (25%) and peripheral venoarterial in 2 (25%) patients. The mean length of the intensive care unit (ICU) stay was 14±7.5 days and of the hospital stay was 34.1±34.2 days. The mean ECMO duration was 9.3±6.6 days with a 50% decannulation rate. Three patients were discharged (37.5%).
Lung transplantation requires complex treatment, and ECMO has allowed extending the indications for transplantation and provided adjuvant support in the clinical management of these patients.
报告在接受肺移植的患者中使用体外膜肺氧合（ECMO）的初步经验。
这是一项来自巴西圣保罗州一个三级中心的回顾性研究，该中心是肺移植的国家参考中心，基于电子病历中前瞻性数据的收集。分析的时间段从 2009 年 1 月（项目开始）延伸至 2018 年 12 月。
共进行了 75 例肺移植，其中 8 例（10.7%）使用 ECMO。患者中 4 例（50%）为女性。平均年龄为 46.4±14.3 岁。导致移植的终末期肺病的病因分别为肺动脉高压 3 例（37.5%）、支气管扩张症 2 例（25%）、肺纤维化 2 例（25%）和肺气肿 1 例（12.5%）。在我们的系列中，7 例（87.5%）为序贯双侧移植。4 例（50%）需要优先考虑，1 例使用 ECMO 作为移植的桥梁。4 例（50%）患者采用中心 ECMO 途径，2 例（25%）患者采用外周静脉-静脉 ECMO 途径，2 例（25%）患者采用外周静脉-动脉 ECMO 途径。重症监护病房（ICU）住院时间平均为 14±7.5 天，住院时间平均为 34.1±34.2 天。ECMO 持续时间平均为 9.3±6.6 天，脱机率为 50%。3 例患者出院（37.5%）。
肺移植需要复杂的治疗，ECMO 允许扩大移植适应证，并在这些患者的临床管理中提供辅助支持。
