Replacing Cardiopulmonary Bypass with Extracorporea; Membrane Oxygenation in Lung Transplantation Operations
Resource
ARTIFICIAL ORGANS v.25 n.8 pp.607-612
Journal
ARTIFICIAL ORGANS
Journal Volume
v.25
Journal Issue
n.8
Pages
607-612
Date Issued
2001
Date
2001
Author(s)
KO, WEN-JE
CHEN, YIH-SHARNG
Abstract
Intraoperative advantages:Cardiopulmonary bypass (CPB) is required in some lung transplantation (LTx) operations. However, it increases risks of bleeding and early graft dysfunction. We report our experiences of replacing CPB with heparinbound extracorporeal membrane oxygenation (ECMO) in LTx operations. If extracorporeal circulation was anticipated for the LTx operations,ECMO support was set up through the femoral venoarteral route after induction of anesthesia; then, LTx was done as usual. Five thousand units of heparin was injected intravenously during the femoral vessel cannulation, but no more was used during the first 24 h of ECMO support. If necessary, as in patients undergoing single LTx for end-stage pulmonary hypertension, the ECMO support was directly extended into the postoperative period until reperfusion edema of the graft lung subsided. Twelve single LTxs and 3 bilateral sequential single LTxs were done under ECMO support. The advantages of using femoral ECMO rather than conventional CB in LTx operations were the operative field was not disturbed by the bypass cannula, stable cardiopulmonary function and normothermia were maintained throughout the operation, there were less blood loss and transfusion requirements, and the left LTx was as easily performed as the right LTx. Red blood cell transfusion requirements during the operation and the first postoperative day were 4.4±2.8 and 2.4±2.0 U,respectively, in 10 adult patients undergoing uncomplicated single LTx with ECMO support, and 4.3±1.3 and 1.5±1.5 U in 8 adult patients undergoing single LTx without any extracorporeal circulatory support. The difference was not significant between the 2 groups(p=0.53 and 0.32 by Mann-Whitney U test) . The ECMO did not increase blood transfusion requirements. In comparsion, 13 U of red blood cell transfusion was required in 2 patients receiving single LTx under CPB support. The ECMO support made the postoperative critical care easier in recipients with graft lung edema. Except for 2 cases of primary gaft failure, the ECMO could be weaned off and removed at bedside within a short period(27.9±24. 6h ,n=13) with no major complications. In conclusion, the heparin-bound femoral ECMO rather than CPB should be used for LTx operations unless concomitant cardiac repair is planned.
Subjects
extracorporeal membrane oxygenation
lung transplantation
cardiopulmonary bypass
Type
journal article