초록접수 현황
| 15F-047 | 구연 발표 |
Bridging to Lung Transplantation with Extracorporeal Membrane Oxygenation for Patients with Progressive Decline of Lung Function
Jin Gu Lee¹, Kyung Sik Nam¹, Young Woo Do¹, Hee Suk Jung¹, Jee Won Suh¹, Chang Yong Lee¹, Seok Jin Haam², Hyo Chae Paik¹
Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea¹, Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea²
Background : Bridging to lung transplantation (LTx) with extracorporeal membrane oxygenation(ECMO) used to be a contraindication due to poor outcome. Recent advance in ECMO device and high mortality rate on the waiting list led to reconsider ECMO as a bridge to LTx. This study was to evaluate early outcomes of patients who underwent ECMO as a bridge to LTx which we have applied in our lung transplantation program since 2010.
Methods : Between 2010 and 2014, 83 patients received LTx in our institution. Among them, 15(18.1%) patients needed an ECMO prior to LTx. We evaluated early outcome of these patients and compared with other non-ECMO bridge patients. (b-ECMO group vs non-ECMO group)
Results : b-ECMO group had shorter waiting time on list (35.27±34.29 day vs. 115.56±149.16 day, p=0.042) and more NYHA class IV (15, 100% vs. 30, 44.1%, p<0.001). Other demographics including age, ABO type, sex and ischemic time were not different. Median duration of preoperative ECMO support was 19.5 days (range 1- 98). The technique of extracorporeal life support was venovenous in 10, venoarterial in 2, and NOVA lung in 3 patients. The disease entity for candidates who required ECMO bridging were 9 pulmonary fibrosis, 3 bronchiolitis obliterance after bone marrow transplantation and 3 other subjects. During operation, all patients in b-ECMO group received double lung transplantation, but in non-ECMO group, 7 patients received single lung transplantation and 51 patients received double lung transplantation. Postoperatively, b-EMCO group needed more ECMO support because of graft dysfunction (12, 80.0% vs. 16, 23.5% p<0.001). Early postoperative recovery times including ventilator support day (38.4 ± 17.66 vs.14.94 ± 24.00, p=0.003) and ICU stay (39.00 ± 58.00 vs. 17.53 ± 23.47, p=0.005) were longer in b-ECMO group. Early (≤30 days) mortality (26.7% vs. 14.7%, p=ns) and 90 day mortality (33.3% vs. 20.6%, p=ns) seemed to occur more frequently in b-ECMO group but statistically was not significant.
Conclusion : ECMO bridging group were more dependent on ECMO support during postoperative period in order to recover and seemed to have poor early outcomes compared to non ECMO bridge group. But given no other option for patients with progressive decline of lung function except death, ECMO bridging can be considered as a life saving strategy for these patients.
Methods : Between 2010 and 2014, 83 patients received LTx in our institution. Among them, 15(18.1%) patients needed an ECMO prior to LTx. We evaluated early outcome of these patients and compared with other non-ECMO bridge patients. (b-ECMO group vs non-ECMO group)
Results : b-ECMO group had shorter waiting time on list (35.27±34.29 day vs. 115.56±149.16 day, p=0.042) and more NYHA class IV (15, 100% vs. 30, 44.1%, p<0.001). Other demographics including age, ABO type, sex and ischemic time were not different. Median duration of preoperative ECMO support was 19.5 days (range 1- 98). The technique of extracorporeal life support was venovenous in 10, venoarterial in 2, and NOVA lung in 3 patients. The disease entity for candidates who required ECMO bridging were 9 pulmonary fibrosis, 3 bronchiolitis obliterance after bone marrow transplantation and 3 other subjects. During operation, all patients in b-ECMO group received double lung transplantation, but in non-ECMO group, 7 patients received single lung transplantation and 51 patients received double lung transplantation. Postoperatively, b-EMCO group needed more ECMO support because of graft dysfunction (12, 80.0% vs. 16, 23.5% p<0.001). Early postoperative recovery times including ventilator support day (38.4 ± 17.66 vs.14.94 ± 24.00, p=0.003) and ICU stay (39.00 ± 58.00 vs. 17.53 ± 23.47, p=0.005) were longer in b-ECMO group. Early (≤30 days) mortality (26.7% vs. 14.7%, p=ns) and 90 day mortality (33.3% vs. 20.6%, p=ns) seemed to occur more frequently in b-ECMO group but statistically was not significant.
Conclusion : ECMO bridging group were more dependent on ECMO support during postoperative period in order to recover and seemed to have poor early outcomes compared to non ECMO bridge group. But given no other option for patients with progressive decline of lung function except death, ECMO bridging can be considered as a life saving strategy for these patients.
책임저자: Hyo Chae Paik
Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
연락처 : Jin Gu Lee, Tel: 02-2228-2140 , E-mail : csjglee@yuhs.ac
