Anesthesiology and Reanimation Department, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey.
Thoracic Surgery Department, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey.
Braz J Cardiovasc Surg. 2023 Feb 10;38(1):88-95. doi: 10.21470/1678-9741-2021-0182.
Lung transplantation is the final treatment option for end-stage lung disease, and extracorporeal membrane oxygenation (ECMO) is increasingly being used during lung transplantation.
The present study aimed to review our initial experience with patients who underwent lung transplantation with or without ECMO since the implementation of the lung transplantation program at our center.
Data were prospectively collected on all patients between December 2016 and December 2018. Patients undergoing ECMO as a bridge to lung transplantation were excluded.
A total of 48 lung transplants were performed, and ECMO was used in 29 (60.4%) cases. Twenty (83%) patients were female. The median age was 48.5 (range, 14-64) years. The most common indications were idiopathic interstitial pneumonia in 9 (31%) patients, chronic obstructive pulmonary disease in 7 (24.1%) patients, and bronchiectasis in 6 (20.7%) patients. Sequential bilateral lung transplantation was performed in all patients. The 30-day mortality was 20.6% (6/29) for patients with ECMO, however, it was 10.5 (2/19) for patients without ECMO (P=0.433). The median length of stay in the intensive care unit (ICU) was 5 (range, 2-25) days. The ECMO weaning rate was 82.8% (24/29). One-year survival was 62.1% with ECMO versus 78.9% without ECMO, and the 3-year survival was 54.1% versus 65.8%, respectively (P=0.317).
ECMO is indicated for more severe patients who underwent lung transplantation. The use of ECMO provides adjuvant support during surgery and the mortality rate is acceptable. Survival is also as similar as non-ECMO patients. ECMO is appropriate for critically ill patients.
肺移植是终末期肺部疾病的最终治疗选择，体外膜肺氧合（ECMO）在肺移植期间的应用越来越多。
本研究旨在回顾分析我们中心肺移植项目实施以来，接受或不接受 ECMO 的肺移植患者的初始经验。
2016 年 12 月至 2018 年 12 月期间，前瞻性收集所有患者的数据。排除作为肺移植桥接使用 ECMO 的患者。
共进行了 48 例肺移植，其中 29 例（60.4%）使用了 ECMO。20 例（83%）患者为女性。中位年龄为 48.5 岁（范围 14-64 岁）。最常见的适应证是特发性间质性肺炎 9 例（31%）、慢性阻塞性肺疾病 7 例（24.1%）和支气管扩张症 6 例（20.7%）。所有患者均进行了序贯双侧肺移植。使用 ECMO 的患者 30 天死亡率为 20.6%（6/29），而未使用 ECMO 的患者为 10.5%（2/19）（P=0.433）。使用 ECMO 的患者 ICU 住院时间中位数为 5 天（范围 2-25 天），ECMO 脱机率为 82.8%（24/29）。使用 ECMO 的患者 1 年生存率为 62.1%，未使用 ECMO 的患者为 78.9%，3 年生存率分别为 54.1%和 65.8%（P=0.317）。
ECMO 适用于接受肺移植的病情更严重的患者。使用 ECMO 可在手术期间提供辅助支持，且死亡率可以接受。生存率与非 ECMO 患者相似。ECMO 适用于危重症患者。
