Perioperative ECMO Use in Lung Transplantation for Severe Pulmonary Hypertension

In patients with end-stage pulmonary artery hypertension (PAH) bilateral lung transplantation (BLTx) is an established treatment. We previously reported on the pre-, intra- and postoperative use of veno-arterial (v-a) extracorporeal membrane oxygenation (ECMO) in these patients. Here we update our experience of BLTx for severe PAH using postoperative awake ECMO. We analysed the outcomes of 31 patients (male, n=10; median age, 46 yr; range, 7-62) transplanted between May 2010 and September 2014. ECMO was started during BLTx and was continued for a minimum of 5 days. After transplantation, early extubation was attempted under continued ECMO support. Before transplantation the mean cardiac index, systolic pulmonary artery pressure and vascular resistance were 2,0 l/min/m2, 108 mm/Hg and 1455 dyn/s/cm-5, respectively. Six patients were bridged to transplantation with v-a ECMO (median 16 days; range 5-33) and 8 patients were re-operated for haematothorax. Respirator and ECMO were weaned after 2 and 8 days (median), respectively, and none de-novo ECMO implantation was required after initial weaning. After ICU treatment for 12 days (median), 30/31 patients recovered and were discharged from hospital (median, 34 days). The 90-day and 1 year survivals in our cohort were 100% and 90%, respectively. Despite of the risk for haematothorax, perioperative use of v-a ECMO for BLTx in patients with severe PAH results in excellent early survival.