Extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation: a meta-analysis

General Thoracic and Cardiovascular Surgery volume 66, pages38–47(2018)Cite this article

Abstract

Background

We reviewed the available literature on patients undergoing lung transplantation supported by cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO).

Methods

A systematic literature search was performed in three databases, in accordance with the PRISMA guidelines. Meta-analyses were used to compare the outcomes of ECMO and CPB procedures.

Results

Seven observational studies met the inclusion criteria incorporating 785 patients. ECMO support showed lower rate of primary graft dysfunction, bleeding, renal failure requiring dialysis, tracheostomy, intraoperative transfusions, intubation time, and hospital stay. Total support time was greater for the ECMO-supported group. No difference was reported between operative and ischemic time.

Conclusions

The present study indicates that the intraoperative use of ECMO is associated with increased efficacy and safety, regarding short-term outcomes, compared to CPB. Well-designed, randomized studies, comparing ECMO to CPB, are necessary to assess their clinical outcomes further.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Cooper JD, Patterson GA, Trulock EP, Washington University Lung Transplant Group. Results of single and bilateral lung transplantation in 131 consecutive recipients. J Thorac Cardiovasc Surg 1994;107(2):460–71.

    CAS  PubMed  Google Scholar 

  2. 2.

    Neurohr C, Huppmann P, Zimmermann G, Leuchte H, Baumgartner R, Hatz R, et al. Munich Lung Transplant Group. Tacrolimus and mycophenolate mofetil as first line immunosuppression after lung transplantation. Transpl Int. 2009;22(6):635–43.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Nagendran M, Maruthappu M, Sugand K. Should double lung transplant be performed with or without cardiopulmonary bypass? Interact Cardiovasc Thorac Surg. 2011;12:799–805.

    Article  PubMed  Google Scholar 

  4. 4.

    Asimakopoulos G, Smith PL, Ratnatunga CP, Taylor KM. Lung injury and acute respiratory distress syndrome after cardiopulmonary bypass. Ann Thorac Surg. 1999;68(3):1107–15.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    McRae K. Con: lung transplantation should not be routinely performed with cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2000;14(6):746–50.

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Diamond JM, Lee JC, Kawut SM, Shah RJ, Localio AR, Bellamy SL, et al. Clinical risk factors for primary graft dysfunction after lung transplantation. Am J Respir Crit Care Med. 2013;187:527–34.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Bermudez CA, Rocha RV, Zaldonis D, Bhama JK, Crespo MM, Shigemura N, et al. Extracorporeal membrane oxygenation as a bridge to lung transplant: midterm outcomes. Ann Thorac Surg. 2011;92:1226–31.

    Article  PubMed  Google Scholar 

  8. 8.

    Fuehner T, Kuehn C, Hadem J, Wiesner O, Gottlieb J, Tudorache I, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med. 2012;187:699–701.

    Google Scholar 

  9. 9.

    Mason DP, Boffa DJ, Murthy SC, Gildea TR, Budev MM, Mehta AC, et al. Extended use of extracorporeal membrane oxygenation after lung transplantation. J Thorac Cardiovasc Surg. 2006;132:954–60.

    Article  PubMed  Google Scholar 

  10. 10.

    Fischer S, Bohn D, Rycus P, Pierre AF, de Perrot M, Waddell TK, et al. Extracorporeal membrane oxygenation after lung transplantation: analysis of the Extracorporeal Life Support Organization (ELSO registry). J Heart Lung Transplant. 2007;26:472–7.

    Article  PubMed  Google Scholar 

  11. 11.

    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100. doi:10.1371/journal.pmed.1000100.

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The cochrane collaboration. 2011 http://www.cochrane-handbook.org.

  13. 13.

    Stang A. Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.

    Article  PubMed  Google Scholar 

  14. 14.

    Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Aigner C, Wisser W, Taghavi S, Lang G, Jaksh P, Czyzewski D, et al. Institutional experience with extracorporeal membrane oxygenation in lung transplantation. Eur J Cardiothorac Surg (2007);31:468–474.

    Article  PubMed  Google Scholar 

  16. 16.

    Bermudez CA, Shiose A, Esper SA, Shigemura N, D’Cunha J, Bhama JK, et al. Outcomes of intraoperative venoarterial extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation. Ann Thorac Surg. 2014;98:1936–43.

    Article  PubMed  Google Scholar 

  17. 17.

    Biscotti M, Yang J, Sonett J, Bacchetta M. Comparison of extracorporeal membrane oxygenation versus cardiopulmonary bypass for lung transplantation. Cardiothoracic Transpl Mech Circ Support. 2014. doi:10.1016/j.jtcvs.2014.07.061.

    Google Scholar 

  18. 18.

    Bittner HB, Binner C, Lehmann S, Kuntze T, Rastan A, Mohr FW. Replacing cardiopulmonary bypass with extracorporeal membrane oxygenation in lung transplantation operations. Eur J Cardio thoracic Surg 2007;31(3):462–7. doi:10.1016/j.ejcts.2006.11.050.

    Article  Google Scholar 

  19. 19.

    Hoechter DJ, Dossow V, Winter H, et al. The Munich lung transplant group: intraoperative extracorporeal circulation in lung transplantation. Thorac Cardiovasc Surg. doi:10.1055/s-0035-1556873.

  20. 20.

    Ius F, Kuehn C, Tudorache I, Sommer W, Avsar M, Boethig D, et al. Lung transplantation on cardiopulmonary support: Venoarterial extracorporeal membrane oxygenation outperformed cardiopulmonary bypass. Thorac Cardiovasc Surg. 2012. doi:10.1016/j.jtcvs.2012.07.095.

    Google Scholar 

  21. 21.

    Machuca TN, Collaud S, Mercier O, Cheung M, Cunningham V, Kim SJ, et al. Outcomes of intraoperative extracorporeal membrane oxygenation versus cardiopulmonary bypass for lung transplantation. Thorac Cardiovasc Surg. 2015. 10.1016/j.jtcvs.2014.11.039.

    Google Scholar 

  22. 22.

    Silliman CC, Paterson AJ, Dickey WO, Stroneck DF, Popovsky MA, Caldwell SA, et al. The association of biologically active lipids with the development of transfusion-related acute lung injury: a retrospective study. Transfusion. 1997;37:719–26.

    Article  Google Scholar 

  23. 23.

    Aeba R, Griffith BP, Kormos RL, Armitage JM, Gasior TA, Fuhrman CR, et al. Effect of cardiopulmonary bypass on early graft dysfunction in clinical lung transplantation. Ann Thorac Surg. 1994;57:715–22.

    Article  Google Scholar 

  24. 24.

    Gammie JS, Cheul Lee J, Pham SM, Keenan RJ, Weyant RJ, Hattler BG, et al. Cardiopulmonary bypass is associated with early allograft dysfunction but not death after double-lung transplantation. J Thorac Cardiovasc Surg. 1998;115:990–7.

    CAS  Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Surgery, University Hospital of Larissa, Larissa, Greece

    Dimitrios E. Magouliotis & Dimitris Zacharoulis

  2. Department of Surgery, Faculty of Medicine, University of Thessaly, Viopolis, Larissa, Greece

    Vasiliki S. Tasiopoulou

  3. Department of Obstetrics and Gynecology, Riverside Regional Medical Center, Newport News, VA, USA

    Alexis A. Svokos

  4. Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA

    Konstantina A. Svokos

Authors
  1. Dimitrios E. Magouliotis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vasiliki S. Tasiopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexis A. Svokos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Konstantina A. Svokos
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dimitris Zacharoulis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dimitrios E. Magouliotis.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

Does not apply.

Informed consent

Does not apply.

Electronic supplementary material

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Magouliotis, D.E., Tasiopoulou, V.S., Svokos, A.A. et al. Extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation: a meta-analysis. Gen Thorac Cardiovasc Surg 66, 38–47 (2018). https://doi.org/10.1007/s11748-017-0836-3

Download citation

Keywords

  • Extracellular membrane oxygenation
  • Cardiopulmonary bypass
  • Lung transplantation
  • ECMO
  • CPB