The comparative impact of central vs. peripheral VA-ECMO cannulation on postoperative graft dysfunction in lung transplantation: a retrospective analysis.

BACKGROUND

Lung transplantation (LTx) is the definitive treatment for end-stage pulmonary diseases, with venoarterial extracorporeal membrane oxygenation (VA-ECMO) used as a common perioperative support. However, it remains unclear if central (cVA-ECMO) or peripheral (pVA-ECMO) cannulation routes yield better outcomes in postoperative prognosis. This study compares the impact of these two cannulation strategies on primary graft dysfunction (PGD) incidence in LTx patients.

METHODS

A retrospective analysis was performed on 153 LTx patients supported with VA-ECMO at the Wuxi Lung Transplant Center (January 2019-March 2023). Patients were divided into central ( = 31) and peripheral ( = 91) groups. Data included recipient/donor demographics, preoperative status, and follow-up outcomes. The primary outcome was PGD within 72 h after reperfusion, whereas secondary outcomes included in-hospital mortality, 1-year survival, renal support needs, ventilation duration, intensive care unit (ICU) stay, and biochemical markers.

RESULTS

PGD incidence was significantly higher in the peripheral group, with longer ECMO duration, ventilation, and ICU stay. Central VA-ECMO showed advantages in in-hospital mortality and 1-year survival rates.

CONCLUSION

Central VA-ECMO cannulation may reduce postoperative complications and improve survival for LTx recipients. Prospective studies are needed to confirm these findings and refine perioperative ECMO management.