The Munich Lung Transplant Group: Intraoperative Extracorporeal Circulation in Lung Transplantation

Abstract

Background This retrospective single-center study aimed to analyze transfusion requirements, coagulation parameters, and outcome parameters in patients undergoing lung transplantation (LuTx) with intraoperative extracorporeal circulatory support, comparing cardiopulmonary bypass (CPB), and extracorporeal membrane oxygenation (ECMO).

Methods Over a 3-year period, 49 of a total of 188 LuTx recipients were identified being set intraoperatively on either conventional CPB (n = 22) or ECMO (n = 27). Intra- and postoperative transfusion and coagulation factor requirements as well as early outcome parameters were analyzed.

Results LuTx patients on CPB had significantly higher intraoperative transfusion requirements when compared with ECMO patients, that is, packed red cells (9 units [5–18] vs. 6 units [4–8], p = 0.011), platelets (3.5 units [2–4] vs. 2 units [0–3], p = 0.034), fibrinogen (5 g [4–6] vs. 0 g [0–4], p = 0.013), prothrombin complex concentrate (3 iU [2–5] vs. 0 iU [0–2], p = 0.001), and tranexamic acid (2.5 mg [2–5] vs. 2.0 mg [1–3], p = 0.002). Also, ventilator support requirements (21days [7–31] vs. 5 days [3–21], p = 0.013) and lengths of ICU stays (36 days [14–62] vs. 15 days [6–44], p = 0.030) were markedly longer in CPB patients. There were no differences in 30-day and 1-year mortality rates.

Conclusion These data indicate a perioperative advantage of ECMO usage with low-dose heparinization over conventional CPB for extracorporeal circulatory support during LuTx. Long-term outcome is not affected.

Keywords

extracorporeal circulation - cardiopulmonary bypass - ECMO - lung transplantation - anticoagulation

Authors' Contribution

D. J. Hoechter and V. von Dossow contributed equally in pre-, intra-, and postoperative patient treatment; designing the study protocol; conducting the analyses, the collection, and interpretation of data; and preparation and revision of the manuscript.

H. W., B. M., C. N., J. B., S. G., C. H., and R. S. participated in pre-, intra-, and postoperative patient treatment; data interpretation and preparation; and revision of the manuscript. H.-H. M. performed the statistical analyses, data interpretation, and revision of the manuscript. R. S. designed the study protocol.

J. B. is a member of the German Center for Lung Research.

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