TY - JOUR
T1 - Intraoperative extracorporeal membrane oxygenation for lung transplantation in cystic fibrosis patients
T2 - Predictors and impact on outcome
AU - Scaravilli, Vittorio
AU - Morlacchi, Letizia Corinna
AU - Merrino, Alessandra
AU - Piacentino, Edoardo
AU - Marasco, Davide
AU - Zanella, Alberto
AU - Nosotti, Mario
AU - Rosso, Lorenzo
AU - Polli, Federico
AU - Blasi, Francesco
AU - Pesenti, Antonio
AU - Grasselli, Giacomo
PY - 2020
Y1 - 2020
N2 - Background: Predictors and outcomes of intraoperative extracorporeal membrane oxygenation (ECMO) during lung transplantation (LUTX) for cystic fibrosis (CF) are unknown. Methods: We retrospectively collected the clinical data at enlistment of the CF patients who underwent double LUTX from January 2013 to December 2018 at an Italian tertiary referral center. We compared blood transfusions, incidence of primary graft dysfunction (PGD), duration of mechanical ventilation, intensive care unit (ICU) length of stay (LOS), hospital LOS and survival of ECMO and non-ECMO patients. Chi-square, Kruskal-Wallis, and log-rank tests were used. Results: Twenty-eight (40%) of the 70 included patients needed intraoperative central veno-arterial ECMO with postoperative veno-venous prolongation in 6 subjects. Lower right ventricle ejection fraction (p = 0.013, OR 0.92(0.86–0.98)), higher oxygen requirement (p = 0.026, OR 1.39(1.01–1.90)), lower body surface area (p = 0.044, OR 0.05(0.00–1.03)), and CF-related diabetes (p = 0.044, OR 2.81(1.03–7.66)) were associated with intraoperative ECMO. Compared to non-ECMO patients, ECMO patients needed almost fivefold intraoperative transfusion (2227 mL vs. 570 mL, p<0.001) and had PGD grade > 0 at 72 h more frequently (16/57% vs. 12/28%, p = 0.017, OR 3.33(1.22–9.09)). Mechanical ventilation, ICU LOS and hospital LOS were significantly longer in ECMO patients. Survival at follow-up (651(326–1277) days) of ECMO and non-ECMO patients was 78% vs. 83%, respectively (OR 0.73 (0.21–2.46), p = 0.616, log-rank test p = 0.498). Conclusion: : Pre-operative risk assessment and clinical planning should be done according to the predictors above. While undeniably useful as a life-saving procedure, ECMO during LUTX for CF is associated with worsened short-term outcomes. ECMO should be implemented weighing its risk and benefits.
AB - Background: Predictors and outcomes of intraoperative extracorporeal membrane oxygenation (ECMO) during lung transplantation (LUTX) for cystic fibrosis (CF) are unknown. Methods: We retrospectively collected the clinical data at enlistment of the CF patients who underwent double LUTX from January 2013 to December 2018 at an Italian tertiary referral center. We compared blood transfusions, incidence of primary graft dysfunction (PGD), duration of mechanical ventilation, intensive care unit (ICU) length of stay (LOS), hospital LOS and survival of ECMO and non-ECMO patients. Chi-square, Kruskal-Wallis, and log-rank tests were used. Results: Twenty-eight (40%) of the 70 included patients needed intraoperative central veno-arterial ECMO with postoperative veno-venous prolongation in 6 subjects. Lower right ventricle ejection fraction (p = 0.013, OR 0.92(0.86–0.98)), higher oxygen requirement (p = 0.026, OR 1.39(1.01–1.90)), lower body surface area (p = 0.044, OR 0.05(0.00–1.03)), and CF-related diabetes (p = 0.044, OR 2.81(1.03–7.66)) were associated with intraoperative ECMO. Compared to non-ECMO patients, ECMO patients needed almost fivefold intraoperative transfusion (2227 mL vs. 570 mL, p<0.001) and had PGD grade > 0 at 72 h more frequently (16/57% vs. 12/28%, p = 0.017, OR 3.33(1.22–9.09)). Mechanical ventilation, ICU LOS and hospital LOS were significantly longer in ECMO patients. Survival at follow-up (651(326–1277) days) of ECMO and non-ECMO patients was 78% vs. 83%, respectively (OR 0.73 (0.21–2.46), p = 0.616, log-rank test p = 0.498). Conclusion: : Pre-operative risk assessment and clinical planning should be done according to the predictors above. While undeniably useful as a life-saving procedure, ECMO during LUTX for CF is associated with worsened short-term outcomes. ECMO should be implemented weighing its risk and benefits.
KW - Cystic fibrosis
KW - Extracorporeal membrane oxygenation
KW - Lung transplantation
KW - Retrospective studies
KW - Risk Factors
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U2 - 10.1016/j.jcf.2019.10.016
DO - 10.1016/j.jcf.2019.10.016
M3 - Article
C2 - 31676344
AN - SCOPUS:85074443065
VL - 19
SP - 659
EP - 665
JO - Journal of Cystic Fibrosis
JF - Journal of Cystic Fibrosis
SN - 1569-1993
IS - 4
ER -