Anesthetic management in lung transplantation: Our single-center experience

Background: In this study, we aimed to discuss our anesthesia management strategies, experiences, and outcomes in patients undergoing lung transplantation. Methods: Between December 2016 and December 2018, a total of 53 patients (43 males, 10 females; mean age: 46.1±13 years; range, 14 to 64 years) undergoing lung transplantation in our center were included. The anesthesia technique, patients" characteristics, and perioperative clinical and follow-up data were recorded. The stage of lung disease was assessed using the New York Heart Association functional classification. Results: Two patients underwent single lung transplantation, while 51 patients underwent double lung transplantation. Idiopathic pulmonary fibrosis was the most common indication in 41.5% of the patients. All patients had end-stage lung disease (Class IV) and 79% were oxygen-dependent. The extracorporeal membrane oxygenation support was given to 32 patients. Conclusion: The anesthetic management of lung transplantation is challenging, either due to the deterioration of the recipient"s physical performance and the complexity of the surgical techniques used. In general, a kind of mechanical support may be needed and extracorporeal membrane oxygenation is the first choice in the majority of patients. A close communication should be maintained between the surgeons, perfusion technicians, and anesthesiologists to ensure an optimal multidisciplinary approach and to achieve successful outcomes.

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The Evolving Role of Extracorporeal Membrane Oxygenation in Lung Transplantation: Implications for Anesthetic Management

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2018.10.007 ◽

2019 ◽

Vol 33 (7) ◽

pp. 1995-2006 ◽

Cited By ~ 12

Author(s):

Jacobo Moreno Garijo ◽

Marcelo Cypel ◽

Karen McRae ◽

Tiago Machuca ◽

Valerie Cunningham ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Lung Transplantation ◽

Anesthetic Management ◽

Membrane Oxygenation

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Long- and short-term clinical impact of awake extracorporeal membrane oxygenation as bridging therapy for lung transplantation

Respiratory Research ◽

10.1186/s12931-021-01905-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Nam Eun Kim ◽

Ala Woo ◽

Song Yee Kim ◽

Ah Young Leem ◽

Youngmok Park ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Lung Transplantation ◽

Lung Disease ◽

Unit Length ◽

Forced Expiratory Volume ◽

Clinical Impact ◽

Short Term ◽

Bridging Therapy ◽

Membrane Oxygenation ◽

End Stage

Abstract Background As lung transplantation (LTx) is becoming a standard treatment for end-stage lung disease, the use of bridging with extracorporeal membrane oxygenation (ECMO) is increasing. We examined the clinical impact of being awake during ECMO as bridging therapy in patients awaiting LTx. Methods In this single-center study, we retrospectively reviewed 241 consecutive LTx patients between October 2012 and March 2019; 64 patients received ECMO support while awaiting LTx. We divided into awake and non-awake groups and compared. Results Twenty-five patients (39.1%) were awake, and 39 (61.0%) were non-awake. The median age of awake patients was 59.0 (interquartile range, 52.5–63.0) years, and 80% of the group was men. The awake group had better post-operative outcomes than the non-awake group: statistically shorter post-operative intensive care unit length of stay [awake vs. non-awake, 6 (4–8.5) vs. 18 (11–36), p < 0.001], longer ventilator free days [awake vs. non-awake, 24 (17–26) vs. 0 (0–15), p < 0.001], and higher gait ability after LTx (awake vs. non-awake, 92% vs. 59%, p = 0.004), leading to higher 6-month and 1-year lung function (forced expiratory volume in 1 s: awake vs. non-awake, 6-month, 77.5% vs. 61%, p = 0.004, 1-year, 75% vs. 57%, p = 0.013). Furthermore, the awake group had significantly lower 6-month and 1-year mortality rates than the non-awake group (6-month 12% vs. 38.5%, p = 0.022, 1-year 24% vs. 53.8%, p = 0.018). Conclusions In patients with end-stage lung disease, considering the long-term and short-term impacts, the awake ECMO strategy could be useful compared with the non-awake ECMO strategy.

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Efficacy of extracorporeal membrane oxygenation for acute respiratory failure with interstitial lung disease; a case control nationwide dataset study in Japan

10.21203/rs.3.rs-152666/v2 ◽

2021 ◽

Author(s):

Yuko Usagawa ◽

Kosaku Komiya ◽

Mari Yamasue ◽

Kiyohide Fushimi ◽

Kazufumi Hiramatsu ◽

...

Keyword(s):

Respiratory Failure ◽

Interstitial Lung Disease ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Acute Respiratory Failure ◽

Lung Transplantation ◽

Lung Disease ◽

Case Control ◽

Antifungal Drugs ◽

Membrane Oxygenation

Abstract Background: Since it is uncertain whether acute respiratory failure in patients with interstitial lung disease is reversible, indications for extracorporeal membrane oxygenation in these patients remain controversial, except for bridging to lung transplantation. The objective of this study was to clarify in-hospital mortality and prognostic factors in interstitial lung disease patients undergoing extracorporeal membrane oxygenation.Methods: Case-control study. Using the Japanese Diagnosis Procedure Combination database from 2010 to 2017, we reviewed hospitalized interstitial lung disease patients receiving invasive mechanical ventilation and extracorporeal membrane oxygenation. As we focused on the efficacy of extracorporeal membrane oxygenation as an intervention for managing merely acute respiratory failure, patients treated with extracorporeal membrane oxygenation as a bridge to lung transplantation were excluded.Results: A total of 164 interstitial lung disease patients receiving extracorporeal membrane oxygenation were included. In-hospital mortality of them was 74.4% (122/164). Compared with survivors, non-survivors were older and received high-dose cyclophosphamide, protease inhibitors, and antifungal drugs more frequently but macrolides and anti-influenza drugs less frequently. Multivariate analysis revealed the following factors were associated with in-hospital mortality: advanced age with an odds ratio (OR) of 1.048 and a 95% confidence interval (CI) of 1.015–1.082, non-use of macrolides (OR, 0.264; 95% CI, 0.118–0.589), and use of antifungal drugs (OR, 3.158; 95% CI, 1.377–7.242).Conclusions: Approximately three quarters of interstitial lung disease patients undergoing extracorporeal membrane oxygenation died in hospital. Moreover, advanced age, non-use of macrolides, and use of antifungal drugs were found to correlate with a poor prognosis.

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Efficacy of Extracorporeal Membrane Oxygenation for Acute Respiratory Failure with Interstitial Lung Disease; A Case Control Nationwide Dataset Study in Japan

10.21203/rs.3.rs-152666/v1 ◽

2021 ◽

Author(s):

Yuko Usagawa ◽

Kosaku Komiya ◽

Mari Yamasue ◽

Kiyohide Fushimi ◽

Kazufumi Hiramatsu ◽

...

Keyword(s):

Respiratory Failure ◽

Interstitial Lung Disease ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Acute Respiratory Failure ◽

Lung Transplantation ◽

Lung Disease ◽

Case Control ◽

Antifungal Drugs ◽

Membrane Oxygenation

Abstract Background: Since it is uncertain whether acute respiratory failure in patients with interstitial lung disease is reversible, indications for extracorporeal membrane oxygenation in these patients remain controversial, except for bridging to lung transplantation. The objective of this study was to clarify in-hospital mortality and prognostic factors in interstitial lung disease patients undergoing extracorporeal membrane oxygenation.Study design and Methods: Case-control study. Using the Japanese Diagnosis Procedure Combination database, we reviewed hospitalized interstitial lung disease patients receiving invasive mechanical ventilation and extracorporeal membrane oxygenation for acute respiratory failure from 2010 to 2017. As we focused on the efficacy of extracorporeal membrane oxygenation as an intervention for managing merely acute respiratory failure, patients treated with extracorporeal membrane oxygenation as a bridge to lung transplantation were excluded.Results: A total of 164 interstitial lung disease patients receiving extracorporeal membrane oxygenation were included, 122 of whom (74.4%) died during hospitalization. Compared with survivors, non-survivors were older and received high-dose cyclophosphamide, protease inhibitors, and antifungal drugs more frequently but macrolides and anti-influenza drugs less frequently. Multivariate analysis revealed the following factors were associated with in-hospital mortality: advanced age with an odds ratio (OR) of 1.048 and a 95% confidence interval (CI) of 1.015–1.082, non-use of macrolides (OR, 0.264; 95% CI, 0.118–0.589), and use of antifungal drugs (OR, 3.158; 95% CI, 1.377–7.242).Conclusions: Approximately three quarters of interstitial lung disease patients undergoing extracorporeal membrane oxygenation died in hospital. Moreover, advanced age, non-use of macrolides, and use of antifungal drugs were found to correlate with a poor prognosis.

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Bridge to Lung Transplantation with Veno-Venous Extracorporeal Membrane Oxygenation for End-Stage Lung Disease: A Single Center Experience

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2013.01.553 ◽

2013 ◽

Vol 32 (4) ◽

pp. S219 ◽

Cited By ~ 1

Author(s):

C.F. Evans ◽

Z.N. Kon ◽

B.P. Wehman ◽

M. Gibber ◽

A.T. Iacono ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Lung Transplantation ◽

Lung Disease ◽

Single Center ◽

Membrane Oxygenation ◽

Single Center Experience ◽

End Stage

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The impact of pre-operative extracorporeal membrane oxygenation support on survival in lung transplantation surgery- ECMO as bridge to transplant

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0031-1297503 ◽

2012 ◽

Vol 60 (S 01) ◽

Author(s):

S Lehmann ◽

S Leontyev ◽

C Binner ◽

J Garbade ◽

MJ Barten ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Lung Transplantation ◽

Bridge To Transplant ◽

Membrane Oxygenation ◽

Transplantation Surgery ◽

The Impact

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Faculty Opinions recommendation of Active rehabilitation and physical therapy during extracorporeal membrane oxygenation while awaiting lung transplantation: a practical approach.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13382984.14750214 ◽

2011 ◽

Author(s):

Alain Vuylsteke ◽

Ivan Wong

Keyword(s):

Physical Therapy ◽

Extracorporeal Membrane Oxygenation ◽

Lung Transplantation ◽

Practical Approach ◽

Membrane Oxygenation ◽

Active Rehabilitation

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10-Year Experience with Postoperatively-Extended Intraoperative Extracorporeal Membrane Oxygenation in Lung Transplantation for Patients with Severe Pulmonary Hypertension

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2021.01.928 ◽

2021 ◽

Vol 40 (4) ◽

pp. S330

Author(s):

M. Franz ◽

K. Aburahma ◽

T. Siemeni ◽

M. Avsar ◽

D. Bobylev ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Extracorporeal Membrane Oxygenation ◽

Lung Transplantation ◽

Severe Pulmonary Hypertension ◽

Membrane Oxygenation

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Chronic respiratory disease and survival outcomes after extracorporeal membrane oxygenation

Respiratory Research ◽

10.1186/s12931-021-01796-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Tak Kyu Oh ◽

Hyoung-Won Cho ◽

Hun-Taek Lee ◽

In-Ae Song

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Lung Disease ◽

Respiratory Disease ◽

Chronic Respiratory Disease ◽

Newly Diagnosed ◽

Membrane Oxygenation ◽

Obstructive Sleep ◽

All Cause Mortality ◽

Ecmo Therapy

Abstract Background Quality of life following extracorporeal membrane oxygenation (ECMO) therapy is an important health issue. We aimed to describe the characteristics of patients who developed chronic respiratory disease (CRD) following ECMO therapy, and investigate the association between newly diagnosed post-ECMO CRDs and 5-year all-cause mortality among ECMO survivors. Methods We analyzed data from the National Health Insurance Service in South Korea. All adult patients who underwent ECMO therapy in the intensive care unit between 2006 and 2014 were included. ECMO survivors were defined as those who survived for 365 days after ECMO therapy. Chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease, lung cancer, lung disease due to external agents, obstructive sleep apnea, and lung tuberculosis were considered as CRDs. Results A total of 3055 ECMO survivors were included, and 345 (11.3%) were newly diagnosed with CRDs 365 days after ECMO therapy. The prevalence of asthma was the highest at 6.1% (185). In the multivariate logistic regression, ECMO survivors who underwent ECMO therapy for acute respiratory distress syndrome (ARDS) or respiratory failure had a 2.00-fold increase in post-ECMO CRD (95% confidence interval [CI]: 1.39 to 2.89; P < 0.001). In the multivariate Cox regression, newly diagnosed post-ECMO CRD was associated with a 1.47-fold (95% CI: 1.17 to 1.86; P = 0.001) higher 5-year all-cause mortality. Conclusions At 12 months after ECMO therapy, 11.3% of ECMO survivors were newly diagnosed with CRDs. Patients who underwent ECMO therapy for ARDS or respiratory failure were associated with a higher incidence of newly diagnosed post-ECMO CRD compared to those who underwent ECMO for other causes. Additionally, post-ECMO CRDs were associated with a higher 5-year all-cause mortality. Our results suggest that ECMO survivors with newly diagnosed post-ECMO CRD might be a high-risk group requiring dedicated interventions.

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