Is Extracorporeal Membrane Oxygenation Withdrawal a Safe Option After Double-Lung Transplantation?

Background. Extracorporeal membrane oxygenation (ECMO) is commonly used during double-lung transplantation. ECMO can be planned or unplanned, and used only during the procedure or extended post-operatively (intraoperative or extended). Our practice is to limit its use and duration as much as possible. We conducted this retrospective single-center study to assess prognoses of patients undergoing unplanned-intraoperative ECMO. Methods. From among 436 patients who underwent double-lung transplantation from 2012 to 2018, we excluded those who underwent bridge-to-transplantation, multiorgan transplantation, repeated transplantation during the study period, and cardiopulmonary bypass. Unplanned-intraoperative ECMO group was compared with no-ECMO and planned-intraoperative ECMO groups. Results. In our sample, 209 patients did not require ECMO, 77 underwent unplanned-intraoperative ECMO, and 14 underwent planned-intraoperative ECMO. One-year and 3-year survival were lower in unplanned-intraoperative ECMO group than in the no-ECMO group (P = .043 and P = .032, respectively). The only independent protective factor related to 1-year mortality was history of cystic fibrosis (P = .013). Lung allocation score (P = .001), grade 3 pulmonary graft dysfunction at end-surgery status (P = .014), and estimated intraoperative blood loss (P = .031) were risk factors. Conclusions. Patients who underwent unplanned-intraoperative ECMO showed poorer prognoses than patients who did not require ECMO. This finding may be explained by differences in initial condition severity, by long-term consequences of the intraoperative complications leading to ECMO pump implantation, or by flaws in our weaning protocol. (C) 2020 by The Society of Thoracic Surgeons