The Predictor for Induction of Extra-Corporeal Membrane Oxygenation (ECMO) in Cadaveric Single-Lung Transplantation: A Retrospective Preliminary Study

Naoya Kobayashi, Hiroaki Toyama, Ryosuke Kudo, Yasushi Matsuda, Yoshinori Okada, Yutaka Ejima, Masanori Yamauchi


Background: The predictive factors of the need for extra-corporeal membrane oxygenation (ECMO) prior to single lung transplantation (SLTX) have not been established yet.

Objective: To clarify the relationships between factors of the lung transplantation recipients and the ECMO need.

Methods: This retrospective observational preliminary study involved adult patients (n=43) who had undergone cadaveric SLTX from 2010 to 2018. All patients had isolated lung ventilation after general anesthesia. Patients were divided into the ECMO use (n=33) and ECMO-free (n=10) groups. We collected and analyzed patients’ background and perioperative data and compared the factors between the two groups.

Results and Conclusion: Before general anesthesia induction, the ECMO-free group had lower HCO3- values than the ECMO use group (24.2±2.6 vs. 28.8±4.4 mmol/L, p=0.007). After induction but before starting the operation, the ECMO-free group had higher mean arterial pressure than the ECMO use group (76.9±10.0 vs. 69.0±8.4 mmHg, p = 0.038). Logistic regression analysis showed a HCO3- cutoff value of 29.9 mmol/L (sensitivity: 96.6%, specificity: 75.0%, AUROC: 0.866, R2: 0.358) and odds ratio of HCO3for ECMO indication of 1.47 (95% confidence interval: 1.19-2.17, p=0.015). Moreover, the ECMO use group had longer operative time (549±92 vs. 409±40 min, p<0.001), larger amount of blood loss (1488±1642 vs. 265±156 g, p=0.001), and longer length of intensive care unit stay (12±9 vs. 26±40 days, p=0.045). Therefore, evaluation of HCO3- could predict the demand of ECMO use in SLTX and the preoperative evaluation of HCO3- has possibility to inhibit unnecessary ECMO.


Lung Transplantation; Extracorporeal Membrane Oxygenation; Prognosis; Retrospective Studies

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 pISSN: 2008-6482
 eISSN: 2008-6490


Creative Commons LicenseThis work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License