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

Abstract

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 HCO₃^- for 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.