The Wythenshawe Hybrid Circuit for lung transplantation: a previously undescribed circuit for lung transplant

Extracorporeal membrane oxygenation is a safe modality of cardiorespiratory support for lung transplantation, with a reduction in coagulopathy and transfusion requirement when compared with cardiopulmonary bypass. In some scenarios, in lung transplantation, there are advantages to the use of cardiopulmonary bypass, which allows cardiac decompression, filtering of embolic air, easy addition and removal of volume, and a means to immediately reintroduce lost blood into circulation. We describe a novel circuit which allows safe and easy switch between modalities without prolonged interruption of flow. This circuit offers a safety net during surgery to minimise the risks influencing the use of extracorporeal membrane oxygenation.

Download Full-text

Outcomes of intraoperative extracorporeal membrane oxygenation versus cardiopulmonary bypass for lung transplantation

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2014.11.039 ◽

2015 ◽

Vol 149 (4) ◽

pp. 1152-1157 ◽

Cited By ~ 98

Author(s):

Tiago N. Machuca ◽

Stephane Collaud ◽

Olaf Mercier ◽

Maureen Cheung ◽

Valerie Cunningham ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Extracorporeal Membrane Oxygenation ◽

Lung Transplantation ◽

Membrane Oxygenation

Download Full-text

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

General Thoracic and Cardiovascular Surgery ◽

10.1007/s11748-017-0836-3 ◽

2017 ◽

Vol 66 (1) ◽

pp. 38-47 ◽

Cited By ~ 23

Author(s):

Dimitrios E. Magouliotis ◽

Vasiliki S. Tasiopoulou ◽

Alexis A. Svokos ◽

Konstantina A. Svokos ◽

Dimitris Zacharoulis

Keyword(s):

Cardiopulmonary Bypass ◽

Extracorporeal Membrane Oxygenation ◽

Lung Transplantation ◽

Meta Analysis ◽

Membrane Oxygenation

Download Full-text

Central, peripheral ECMO or CPB? Comparsion between circulatory support methods used during lung transplantation

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01719-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Nikola Ruszel ◽

Kajetan Kiełbowski ◽

Maria Piotrowska ◽

Michał Kubisa ◽

Tomasz Grodzki ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Gas Exchange ◽

Extracorporeal Membrane Oxygenation ◽

Lung Transplantation ◽

Survival Rates ◽

Usual Interstitial Pneumonia ◽

Circulatory Support ◽

Thromboembolic Complications ◽

Membrane Oxygenation ◽

Chi Square Analysis

Abstract Background Chronic obstructive pulmonary disease, cystic fibrosis and usual interstitial pneumonia are three most common indications for lung transplantation (LuTx) in Poland. As a result of irreversible destruction of pulmonary parenchyma and extended respiratory insufficiency that appear afterwards, it is crucial to estimate the reserve of gas exchange in each lung before and during surgery. Altering conditions of gas exchange require adaptation in circulatory system as well. In some of the cases the use of extracorporeal life support appears to be necessary to undergo the transplantation successfully. Cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) used during operation allow to replace the function of heart and lung, but they are also related to complications in the form of acute kidney failure, bleeding, heart arrhythmias or thromboembolic complications. Methods We reviewed 77 LuTx from 2009 to 2020 performed at the Department of Thoracic Surgery and Transplantation. 40/77 (51%) patients required intraoperative extracorporeal assistance: 8 required CBP and 32 required ECMO. In the ECMO group 14/32 (44%) patients had peripheral cannulation and 18/32 (56%) had central one. We have calculated the survival rates and reviewed postoperative complications after lung transplantations. Cumulative Kaplan–Meier survival curves were calculated. Differences between the groups were evaluated by the Chi- square analysis for discontinuous variables and t-test for continuous variables. Results The use of intraoperative central extracorporeal membrane oxygenator was associated with increased survival rates comparing to patients without external support (30-days, 1-year, 3-years, 5-years rates: 78%, 66%, 66%, 66% vs 83%, 65%, 59%, 44% respectively). Furthermore, survival was enhanced comparing to peripheral ECMO or cardiopulmonary bypass as well (50%, 41%, 41%, 33%; 75%, 50%, 50%, 38% respectively). Acute kidney injury and thromboembolic complications occurred statistically more often in case of patients that underwent lung transplantation with support devices (p = 0.005, p = 0.02 respectively). Frequency of other complications was comparable among groups. Conclusions The use of central extracorporeal membrane oxygenation should be favorized over peripheral cannulation or cardiopulmonary bypass. CPB should be no longer used during LuTx. Trial registration Not applicable.

Download Full-text