EXPERIENCE WITH APPLICATION OF EXTRACORPOREAL MEMBRANE OXYGENATION IN DOUBLE LUNG TRANSPLANTATION

The most reliable intraoperative mechanical extracorporeal support is conventional сardiopulmonary bypass (CPB). However, CPB increases a risk of intraoperative bleeding and primary graft dysfunction. ECMO is more benefi cial method of intraoperative cardiopulmonary support than CPB in LTx.

Aim. 10 LTx were retrospectively analyzed in the period from 01.2012 till 01.2014.

Methods. Indications for ECMO were acute grafts edema after reperfusion (n = 4, group I). In group II (n = 6) indications for ECMO were severe hypoxia (РаО2 and FiO2 ratio < 1,0) and/or acidosis (pH < 7,2) during one lung ventilation. We used central type of veno-arterial ECMO: right atrium to ascending aorta.

Results. Intraoperative ECMO lasted 4,1 ± 1,0 hours in group I and 8,5 ± 0,7 hours in group II. ECMO was prolonged into postoperative period in all patients from group I due to primary graft dysfunction. Application of ECMO in group II enabled to stabilize gas exchange and circulation as well as to decrease pulmonary arterial pressure in the time of reperfusion. ECMO was fi nished just after transplantation in group II. The 1-year survival in group I and II was 75,0 and 83,3%, respectively.

Conclusion. Central veno-arterial ECMO is an adequate method of intraoperative cardiopulmonary support in LTx. It prevents postreperfusion edema of the lung grafts.

1. Yao and Artusio's Anesthesiology: Problem-Oriented Patient Management / Eds. Yao F.-S.F., Malhotra V., Fontes M.L. 7th ed. Lippincott Williams & Wilkins. 2011: 1376.

2. Szeto W.Y., Kreisel D., Karakousis G.C., Pochettino A.,Sterman D.H., Kotloff R.M. et al. Cardiopulmonary bypass for bilateral sequential lung transplantation in patients with chronic obstructive pulmonary disease without adverse effect on lung function or clinical outcome. Thorac. Cardiovasc. Surg. 2002; 124 (2): 241–249.

3. Hill J.D., O'Brien T.G., Murray J.J., Dontigny L., Bramson M.L., Osborn J.J. et al. Prolonged Extracorporeal Oxygenation for Acute Post-Traumatic Respiratory Failure (Shock-Lung Syndrome). Use of the Bramson Membrane Lung. New Engl. J. Medicine. 1972; 286 (12):629–634.

4. Шаталов К.В., Бродский А.Г. Использование метода экстракорпоральной мембранной оксигенации в детской кардиохирургии при сердечно-легочной недостаточности (обзор литературы). Детские болезни сердца и сосудов. 2012; 1 (3): 4–8. Shatalov K.V., Brodskiy A.G. Use of extracorporeal membrane oxygenation in child cardiosurgery with cardiopulmonary failure (review of literature). Child deseases of hurt and vessels. 2012; 1 (3): 4–8. [In Rus]

5. Aeba R., Griffi th B.P., Kormos R.L., Armitage J.M., Gasior T.A., Fuhrman C.R. et al. Effect of cardiopulmonary bypass on early graft dysfunction in clinical lung transplantation. Ann. Thorac. Surg. 1994; 57 (3): 715–722.

6. Gammie J.S., Cheul L.J., Pham S.M., Keenan R.J., Weyant R.J., Hattler B.G. et al. Cardiopulmonary bypass is associated with early allograft dysfunction but not death after double-lung transplantation. J. Thorac. Cardiovasc. Surg. 1998; 115 (5): 990–997.

7. Nagendran M., Maruthappu M., Sugand K. Should double lung transplant be performed with or without сardiopulmonary bypass? Interact. Cardiovasc. Thorac. Surg. 2011; 12 (5): 799–805.

8. Boer W.J., Hepkema B.G., Loef B.G., van der Bij W., Verschuuren E.A., de Vries H.J. et al. Survival benefi t of сardiopulmonary bypass support in bilateral lung transplantation for emphysema patients. Transplantation. 2002:

9. (10): 1621–1627.

10. Gu Y.J., van Oeveren W., Boonstra P.W., de Haan J., Wildevuur C.R. Leukocyte activation with increased expression of CR3 receptors during cardiopulmonary bypass. Ann. Thorac. Surg. 1992; 53 (5): 839–843.

11. Hlozek C.C., Smedira N.G., Kirby T.J., Patel A.N., Perl M. Cardiopulmonary bypass (CPB) for lung transplantation. Perfusion. 1997; 12 (2): 107–112.

12. Aigner C., Wisser W., Taghavi S., Lang G., Jaksch P., Czyzewski D. et al. Institutional experience with extracorporeal

13. membrane oxygenation in lung transplantation. Eur. J. Cardiothorac. Surg. 2007; 31 (3): 468–474.

14. Lick S.D., Brown P.S., Kurusz M., Vertrees R.A., McQuitty C.K., Johnston W.E. Technique of controlled reperfusion of the transplanted lung in humans. Ann. Thorac. Surg. 2000; 69 (3): 910–912.

15. Olsson K.M., Simon A., Strueber M., Hadem J., Wiesner O., Gottlieb J. et al. Extracorporeal membrane oxygenation in nonintubated patients as bridge to lung transplantation. Am. J. Transplant. 2010; 10 (9): 2173–2178.

16. Strueber M., Hoeper M.M., Fischer S., Laks H., Saggar R., Lynch J.P. 3rd et al. Bridge to thoracic organ transplantation in patients with pulmonary arterial hypertension using a pumpless lung assist device. Am. J. Transplant. 2009; 9 (4): 853–857.

17. Попцов В.Н., Спирина Е.А., Саитгареев Р.Ш., Шумаков Д.В., Захаревич В.М., Слободянник В.В. и др. Периферическая вено-артериальная мембранная оксигенация как метод механической поддержки кровообращения перед трансплантацией сердца. Вестн. трансплантологии. 2013; 2: 23–35. Poptsov V.N., Spirina E. A., Saitgareev R.S., Shumakov D.V., Zakharevich V.M., Slobodyannik V.V. et al. Peripheral veno-arterial ecmo as a mechanical circulatory support before heart transplantation. Bulletin of transplantology and artifi cial organs. 2013; 2: 23–35. [In Rus]

18. Fischer S., Bohn D., Rycus P., Pierre A.F., de Perrot M., Waddell T.K. et al. Extracorporeal membrane oxygenation for primary graft dysfunction after lung transplantation: analysis of the Extracorporeal Life Support Organization (ELSO) registry. Heart Lung Transplant. 2007; 26 (5): 472–477.

19. Zapol W.M., Snider M.T., Hill J.D., Fallat R.J., Bartlett R.H., Edmunds L.H. et al. Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA. 1979; 242 (20): 2193–2196.

20. Peek G.J., Killer H.M., Reeves R., Sosnowski A.W., Firmin R.K. Early experience with a polymethylpentene oxygenator for adult extracorporeal life support. ASAIO J. 2002; 48 (5): 480–482.

21. Козлов И.А., Романов А.А. Маневр открытия («мобилизация») альвеол при интраоперационном нарушении оксигенирующей функции легких у кардиохирургических больных. Анестезиология и реаниматология. 2007; 2: 27–30. Kozlov I.A., Romanov A.A. Alveoluses opening («mobilization») in intraoperative disorders of gaze-exchange lung function in cardiosurgical patients. Anesth and Int Care Manaegment. 2007; 2: 27–30. [In Rus]

22. Apostolakis E., Filos K.S., Koletsis E., Dougenis D. Lung dysfunction following cardiopulmonary bypass. J. Card. Surg. 2010; 25 (1): 47–55.

23. Rady M.Y., Ryan T., Starr N.J. Early onset of acute pulmonary dysfunction after cardiovascular surgery: risk factors and сlinical outcome. Crit. Care Med. 1997; 25 (11): 1831–1839.

24. Halldorsson A.O., Kronon M., Allen B.S., Rahman S., Wang T. Lowering reperfusion pressure reduces the injury after pulmonary ischemia. Ann. Thorac. Surg. 2000; 69 (1): 198–203.

25. de Perrot M., Liu M., Waddell T.K., Keshavjee S. Ischemia-reperfusion-induced lung injury. Am. J. Respir. Crit. Care Med. 2003; 167 (4): 490–511.

26. Halldorsson A.O., Kronon M., Allen B.S., Rahman S., Wang T., Layland M. et al. Controlled reperfusion prevents pulmonary injury after 24 hours of lung preservation. Ann. Thorac. Surg. 1998; 66 (3): 877–884.

27. Schnickel G.T., Ross D.J., Beygui R., Shefi zadeh A., Laks H., Saggar R. et al. Modifi ed reperfusion in clinical lung transplantation: the results of 100 consecutive cases. Thorac. Cardiovasc. Surg. 2006. 131 (1). 218–223.

28. Khalpey Z., Gilfeather M.S., Camp P.C.Jr., Jaklitsch M.T. Controlled antegrade single lung reperfusion during double lung transplant. Interact. Cardiovasc. Thorac. Surg. 2009; 9 (6): 932–933.