TY - JOUR
T1 - A comparison of cardiopulmonary bypass versus extracorporeal membrane oxygenation
T2 - Does intraoperative circulatory support strategy affect outcomes in pediatric lung transplantation?
AU - Parikh, Amisha N.
AU - Merritt, Taylor C.
AU - Carvajal, Horacio G.
AU - Shepard, Mark S.
AU - Canter, Matthew W.
AU - Abarbanell, Aaron M.
AU - Eghtesady, Pirooz
AU - Nath, Dilip S.
N1 - Publisher Copyright:
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2021/6
Y1 - 2021/6
N2 - Objective: Data on adult lung transplantation suggest perioperative benefits of intraoperative extracorporeal membrane oxygenation (ECMO) compared to cardiopulmonary bypass (CPB). Information regarding their pediatric counterparts, however, is limited. This study compares outcomes of intraoperative ECMO versus CPB in pediatric lung transplantation. Methods: We reviewed all pediatric lung transplants at our institution from 2014 to 2019 and compared those supported intraoperatively on ECMO (n = 13) versus CPB (n = 22), plus a conditional analysis excluding re-transplantations (ECMO [n = 13] versus CPB [n = 20]). We evaluated survival, surgical times, intraoperative transfusions, postoperative support, complications, and duration of hospitalization. Results: Total time on ECMO support was significantly less than that of CPB support (P =.018). Intraoperatively, the ECMO group required fewer transfusions of fresh-frozen plasma (8.9 [5.8-22.3] vs 16.6 [11.4-39.0] mL/kg, P =.049) and platelets (4.2 [0.0-6.7] vs 8.0 [3.5-14.0] mL/kg, P =.049). When excluding re-transplantations, patients on ECMO required fewer packed red blood cells intraoperatively (12.6 [2.1-30.7] vs 28.2 [14.0-54.0] mL/kg, P =.048). There were no differences in postoperative support requirements, complications, or mortality at one, six, and twelve months. Conclusions: Intraoperative ECMO support during pediatric lung transplantation appears to decrease intraoperative transfusion requirements when compared to CPB. Data from additional institutions may strengthen these observations.
AB - Objective: Data on adult lung transplantation suggest perioperative benefits of intraoperative extracorporeal membrane oxygenation (ECMO) compared to cardiopulmonary bypass (CPB). Information regarding their pediatric counterparts, however, is limited. This study compares outcomes of intraoperative ECMO versus CPB in pediatric lung transplantation. Methods: We reviewed all pediatric lung transplants at our institution from 2014 to 2019 and compared those supported intraoperatively on ECMO (n = 13) versus CPB (n = 22), plus a conditional analysis excluding re-transplantations (ECMO [n = 13] versus CPB [n = 20]). We evaluated survival, surgical times, intraoperative transfusions, postoperative support, complications, and duration of hospitalization. Results: Total time on ECMO support was significantly less than that of CPB support (P =.018). Intraoperatively, the ECMO group required fewer transfusions of fresh-frozen plasma (8.9 [5.8-22.3] vs 16.6 [11.4-39.0] mL/kg, P =.049) and platelets (4.2 [0.0-6.7] vs 8.0 [3.5-14.0] mL/kg, P =.049). When excluding re-transplantations, patients on ECMO required fewer packed red blood cells intraoperatively (12.6 [2.1-30.7] vs 28.2 [14.0-54.0] mL/kg, P =.048). There were no differences in postoperative support requirements, complications, or mortality at one, six, and twelve months. Conclusions: Intraoperative ECMO support during pediatric lung transplantation appears to decrease intraoperative transfusion requirements when compared to CPB. Data from additional institutions may strengthen these observations.
KW - cardiopulmonary bypass
KW - extracorporeal membrane oxygenation (ECMO)
KW - lung transplant
KW - pediatric
UR - http://www.scopus.com/inward/record.url?scp=85103208144&partnerID=8YFLogxK
U2 - 10.1111/ctr.14289
DO - 10.1111/ctr.14289
M3 - Article
C2 - 33714228
AN - SCOPUS:85103208144
SN - 0902-0063
VL - 35
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 6
M1 - e14289
ER -