Korean J Crit Care Med.  2015 Nov;30(4):286-294. 10.4266/kjccm.2015.30.4.286.

Perioperative Risk Factors associated with Immediate Postoperative Extracorporeal Membrane Oxygenation in Lung Transplants

• Kim HY
• Na S
• Paik HC
• Ha J
• Kim J

• KMID: 2156182
• DOI: http://doi.org/10.4266/kjccm.2015.30.4.286

Abstract

BACKGROUND
Extracorporeal membrane oxygenation (ECMO) is administered for a few days after lung transplantation (LTx) in recipients who are expected to have early graft dysfunction. Despite its life-saving potential, immediate postoperative ECMO has life-threatening complications such as postoperative bleeding. We investigated the risk factors related to the use of immediate postoperative ECMO.
METHODS
We retrospectively reviewed the records of 60 LTx patients who were at our institution from October 2012 to May 2015. Perioperative variables associated with postoperative ECMO were compared between the two groups.
RESULTS
There were 26 patients who received postoperative ECMO (ECMO group) and 34 patients who did not (control group). Multivariate regression analysis revealed preoperative ECMO (odds ratio [OR] 12.55, 95% confidence intervals [CI] 1.34 - 117.24, p = 0.027) and lower peripheral pulse oxymetry saturation (SpO2) at the end of surgery (OR 0.71, 95% CI 0.54 - 0.95, p = 0.019) were independent risk factors for postoperative ECMO in LTx patients. The incidences of complications, such as re-operation, tracheostomy, renal failure and postoperative atrial fibrillation, were higher in the ECMO group. There was no difference in the duration of postoperative intensive care unit stay or postoperative 30-day mortality between the two groups.
CONCLUSIONS
The preoperative ECMO and lower SpO2 at the end of surgery were associated with postoperative ECMO. Further, postoperative adverse events were higher in the ECMO group compared with the control group. This study suggests that determination of postoperative ECMO requires careful consideration because of the risks of postoperative ECMO in LTx patients.

Keyword

extracorporeal membrane oxygenation; lung transplantation; perioperative; risk factor; weaning

MeSH Terms

Atrial Fibrillation
Extracorporeal Membrane Oxygenation*
Hemorrhage
Humans
Incidence
Intensive Care Units
Lung Transplantation
Lung*
Mortality
Renal Insufficiency
Retrospective Studies
Risk Factors*
Tracheostomy
Transplants
Weaning

Figure

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  Fig. 1. Receiver operating characteristic (ROC) curve for multiple regression model. The area under the receiver operating characteristic curve was 0.727 (95% CI 0.59-0.86, p = 0.003).

Reference

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