Veno-arterial-venous extracorporeal membrane oxygenation in the perioperative management of lung transplantation:a single-center experience with 29 cases
Wang Dapeng
Xu Zhongping
Wang Haixiang
Wang Yifeng
Zhou Tao
Xu Hongyang
Abstract：Objective To evaluate the clinical efficacy of veno-arterial-venous extracorporeal membrane oxygenation(V-A-V ECMO)in perioperative management of lung transplantation.Methods A retrospective analysis was performed on 29 lung transplant patients receiving V-A-V ECMO at Wuxi People's Hospital from January 2015 to September 2024.Data included demographics,ECMO cannulation strategies,initial configurations,mode conversion timing,weaning time,and prognosis.The cohort comprised 19 males and 10 females,with underlying diagnoses of interstitial pulmonary fibrosis(n=18),primary pulmonary hypertension(n=4),silicosis(n=3),chronic obstructive pulmonary disease(n=2),and bronchiectasis(n=2).Nine patients underwent single-lung transplantation,and 20 underwent bilateral lung transplantation.ECMO was applied preoperatively for bridging(n=2)and intra-/postoperatively for cardiopulmonary support(n=27).Initial ECMO modes included:V-V ECMO(n=6),V-A ECMO(n=10),peripheral V-A-V ECMO(n=9),and central V-A-V ECMO(n=4).Due to malignant arrhythmia,cardiogenic shock,cardiac arrest,graft dysfunction(PGD)and other reasons during or after surgery,Six patients with initial V-V mode were converted to V-A-V via femoral artery intubation.Ten patients with initial V-A mode were converted to V-A-V ECMO via right internal jugular vein catheterization.Nine patients received direct V-A-V ECMO assistance during surgery.Four patients underwent central V-A-V ECMO during surgery,and after the operation,femoral artery intubation was performed to convert to peripheral V-A-V ECMO.Results Among the patients,11 underwent hemofiltration therapy,and 4 underwent tracheostomy postoperatively.Seventeen patients(58.6%)survived perioperatively,and 21(72.4%)were successfully weaned from ECMO.Eight patients failed to wean due to unimproved cardiac/pulmonary function and ultimately died or discontinued treatment.Conclusion V-A-V ECMO serves as a viable rescue strategy for lung transplant recipients with concurrent respiratory and circulatory failure during the perioperative phase.
Keywords：Lung transplantationPerioperative periodVeno-arterio-venous extracorporeal membrane oxygenation
Publication Date：2025-06-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 219-224 )