Transfusion Requirements During Lung Transplantation: Elective VA ECMO Vs. Off-Pump

Purpose Elective venoarterial extracorporeal membrane oxygenation (VA ECMO) during bilateral orthotopic lung transplantation (BOLT) is becoming widely practiced. Compared to off-pump (OP) procedures, ECMO has been described to increase bleeding and transfusion requirements. In this retrospective observational study, we propose that the use of elective VA ECMO in low-risk transplant recipients would have similar transfusion requirements compared to a matched, historical OP cohort. Methods Patients who underwent BOLT from 1/1/17 to 9/6/20 were included. On 2/1/2020, all BOLTS were performed on elective VA ECMO. Those who required cardiopulmonary bypass, concomitant cardiac surgery, re-transplantation, preoperative ECMO, or had severe pulmonary hypertension (mean PA pressures >40 mmHg) were excluded. Patients were grouped into an OP historical cohort and elective VA ECMO support with being matched based on age, transplant indication, and ischemic time. Primary outcomes were intraoperative and 72-hour total transfusion requirements. Secondary outcomes included length-of-stay (LOS) and primary graft dysfunction (PGD) at 72 hours. Results 383 BOLTs were identified over the study period and 38 matched pairs were compared. Donor, recipient, and procedural characteristics were similar between groups. The OP and VA ECMO group had similar intra-operative transfusion requirements [packed red blood cells (1 vs. 1) p=0.312; fresh frozen plasma (0 vs. 0) p>0.999; and platelets (0 vs. 0) p>0.999; Table 1]. The VA ECMO group had a significantly higher rate of cryoprecipitate transfusions (1 vs. 0 p=0.02; Table 1). Differences in 72-hour transfusions were not statistical significance (2 OP vs. 4 VA ECMO, p=0.085). There were no significant differences in PGD at 72-hours or LOS. Conclusion Patients undergoing BOLT on VA ECMO have similar rates of perioperative transfusions requirements when compared to a patched historical off-pump control group. WE did not observe differences in PGD and LOS between groups.