Central, peripheral ECMO or CPB? Comparsion between circulatory support methods used during lung transplantation

Abstract Background Chronic obstructive pulmonary disease, cystic fibrosis and usual interstitial pneumonia are three most common indications for lung transplantation (LuTx) in Poland. As a result of irreversible destruction of pulmonary parenchyma and extended respiratory insufficiency that appear...

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Autores principales:	Nikola Ruszel, Kajetan Kiełbowski, Maria Piotrowska, Michał Kubisa, Tomasz Grodzki, Janusz Wójcik, Bartosz Kubisa
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Lung transplantation ECMO CPB ECC Surgery RD1-811 Anesthesiology RD78.3-87.3
Acceso en línea:	https://doaj.org/article/d589119b7a084d089adda1f4b497eea5
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spelling	oai:doaj.org-article:d589119b7a084d089adda1f4b497eea52021-11-28T12:31:00ZCentral, peripheral ECMO or CPB? Comparsion between circulatory support methods used during lung transplantation10.1186/s13019-021-01719-01749-8090https://doaj.org/article/d589119b7a084d089adda1f4b497eea52021-11-01T00:00:00Zhttps://doi.org/10.1186/s13019-021-01719-0https://doaj.org/toc/1749-8090Abstract Background Chronic obstructive pulmonary disease, cystic fibrosis and usual interstitial pneumonia are three most common indications for lung transplantation (LuTx) in Poland. As a result of irreversible destruction of pulmonary parenchyma and extended respiratory insufficiency that appear afterwards, it is crucial to estimate the reserve of gas exchange in each lung before and during surgery. Altering conditions of gas exchange require adaptation in circulatory system as well. In some of the cases the use of extracorporeal life support appears to be necessary to undergo the transplantation successfully. Cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) used during operation allow to replace the function of heart and lung, but they are also related to complications in the form of acute kidney failure, bleeding, heart arrhythmias or thromboembolic complications. Methods We reviewed 77 LuTx from 2009 to 2020 performed at the Department of Thoracic Surgery and Transplantation. 40/77 (51%) patients required intraoperative extracorporeal assistance: 8 required CBP and 32 required ECMO. In the ECMO group 14/32 (44%) patients had peripheral cannulation and 18/32 (56%) had central one. We have calculated the survival rates and reviewed postoperative complications after lung transplantations. Cumulative Kaplan–Meier survival curves were calculated. Differences between the groups were evaluated by the Chi- square analysis for discontinuous variables and t-test for continuous variables. Results The use of intraoperative central extracorporeal membrane oxygenator was associated with increased survival rates comparing to patients without external support (30-days, 1-year, 3-years, 5-years rates: 78%, 66%, 66%, 66% vs 83%, 65%, 59%, 44% respectively). Furthermore, survival was enhanced comparing to peripheral ECMO or cardiopulmonary bypass as well (50%, 41%, 41%, 33%; 75%, 50%, 50%, 38% respectively). Acute kidney injury and thromboembolic complications occurred statistically more often in case of patients that underwent lung transplantation with support devices (p = 0.005, p = 0.02 respectively). Frequency of other complications was comparable among groups. Conclusions The use of central extracorporeal membrane oxygenation should be favorized over peripheral cannulation or cardiopulmonary bypass. CPB should be no longer used during LuTx. Trial registration Not applicable.Nikola RuszelKajetan KiełbowskiMaria PiotrowskaMichał KubisaTomasz GrodzkiJanusz WójcikBartosz KubisaBMCarticleLung transplantationECMOCPBECCSurgeryRD1-811AnesthesiologyRD78.3-87.3ENJournal of Cardiothoracic Surgery, Vol 16, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Lung transplantation ECMO CPB ECC Surgery RD1-811 Anesthesiology RD78.3-87.3
spellingShingle	Lung transplantation ECMO CPB ECC Surgery RD1-811 Anesthesiology RD78.3-87.3 Nikola Ruszel Kajetan Kiełbowski Maria Piotrowska Michał Kubisa Tomasz Grodzki Janusz Wójcik Bartosz Kubisa Central, peripheral ECMO or CPB? Comparsion between circulatory support methods used during lung transplantation
description	Abstract Background Chronic obstructive pulmonary disease, cystic fibrosis and usual interstitial pneumonia are three most common indications for lung transplantation (LuTx) in Poland. As a result of irreversible destruction of pulmonary parenchyma and extended respiratory insufficiency that appear afterwards, it is crucial to estimate the reserve of gas exchange in each lung before and during surgery. Altering conditions of gas exchange require adaptation in circulatory system as well. In some of the cases the use of extracorporeal life support appears to be necessary to undergo the transplantation successfully. Cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) used during operation allow to replace the function of heart and lung, but they are also related to complications in the form of acute kidney failure, bleeding, heart arrhythmias or thromboembolic complications. Methods We reviewed 77 LuTx from 2009 to 2020 performed at the Department of Thoracic Surgery and Transplantation. 40/77 (51%) patients required intraoperative extracorporeal assistance: 8 required CBP and 32 required ECMO. In the ECMO group 14/32 (44%) patients had peripheral cannulation and 18/32 (56%) had central one. We have calculated the survival rates and reviewed postoperative complications after lung transplantations. Cumulative Kaplan–Meier survival curves were calculated. Differences between the groups were evaluated by the Chi- square analysis for discontinuous variables and t-test for continuous variables. Results The use of intraoperative central extracorporeal membrane oxygenator was associated with increased survival rates comparing to patients without external support (30-days, 1-year, 3-years, 5-years rates: 78%, 66%, 66%, 66% vs 83%, 65%, 59%, 44% respectively). Furthermore, survival was enhanced comparing to peripheral ECMO or cardiopulmonary bypass as well (50%, 41%, 41%, 33%; 75%, 50%, 50%, 38% respectively). Acute kidney injury and thromboembolic complications occurred statistically more often in case of patients that underwent lung transplantation with support devices (p = 0.005, p = 0.02 respectively). Frequency of other complications was comparable among groups. Conclusions The use of central extracorporeal membrane oxygenation should be favorized over peripheral cannulation or cardiopulmonary bypass. CPB should be no longer used during LuTx. Trial registration Not applicable.
format	article
author	Nikola Ruszel Kajetan Kiełbowski Maria Piotrowska Michał Kubisa Tomasz Grodzki Janusz Wójcik Bartosz Kubisa
author_facet	Nikola Ruszel Kajetan Kiełbowski Maria Piotrowska Michał Kubisa Tomasz Grodzki Janusz Wójcik Bartosz Kubisa
author_sort	Nikola Ruszel
title	Central, peripheral ECMO or CPB? Comparsion between circulatory support methods used during lung transplantation
title_short	Central, peripheral ECMO or CPB? Comparsion between circulatory support methods used during lung transplantation
title_full	Central, peripheral ECMO or CPB? Comparsion between circulatory support methods used during lung transplantation
title_fullStr	Central, peripheral ECMO or CPB? Comparsion between circulatory support methods used during lung transplantation
title_full_unstemmed	Central, peripheral ECMO or CPB? Comparsion between circulatory support methods used during lung transplantation
title_sort	central, peripheral ecmo or cpb? comparsion between circulatory support methods used during lung transplantation
publisher	BMC
publishDate	2021
url	https://doaj.org/article/d589119b7a084d089adda1f4b497eea5
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_version_	1718407922974720000

Central, peripheral ECMO or CPB? Comparsion between circulatory support methods used during lung transplantation

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