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Transplantation |

Extracorporeal Membrane Oxygenation System in the Early Postoperative Period After Lung Transplantation

José González García, MD; Sebastian Peñafiel, MD; Eugenia Libreros Niño, MD; Diana Baquero Velandia, MD; Victor Calvo Medina, PhD; Carlos Jordá Aragón, MD; Gabriel Sales Badia, PhD; Juan Escrivá, MD; Ángel García Zarza, MD; Juan Pastor Guillem, PhD
Author and Funding Information

La Fe University Hospital, Valencia, Spain


Chest. 2014;145(3_MeetingAbstracts):632A. doi:10.1378/chest.1824432
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Abstract

SESSION TITLE: Transplantation Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: We want to share our experience with extracorporeal membrane oxigenation system (ECMO) in the management of a primary graft dysfunction after lung transplantation.

METHODS: We present 6 cases of lung primary graft dysfunction, that needed ECMO for lung recovery or second lung transplantation: - Primary lung graft dysfunction: 1) A 9-year-old female with cystic fibrosis with an emergency bipulmonary-lobar transplantation. 2) A 47 year-old-female with COPD with a right lung transplantation. 3) A 55-year-old female with COPD and previous pulmonary embolism that had a bipulmonary transplantation. 4) A 33-year-old male with pulmonary fibrosis after H1N1 infection with a bipulmonary transplantation, that presented an A2 graft rejection and early respiratory distress syndrome. - Bridge to second transplantation: 1) A 37-year-old male with Langerhan's cell histiocytosis with bipulmonary transplantation and humoral allograft rejection. 2) A 62-year-old male with COPD with a right lung transplantation and primary lung graft dysfunction with arterial embolism. ECMO in venous-arterial (VA) mode was used in the cases that needed cardiac assistance, and veno-venous (VV) mode in the rest of them.

RESULTS: From the 6 previously presented patients we have a 50% survival rate. ECMO had successfull results before 10 days in 83.3% of the cases. Oxigen-arterial-pressure (PaO2) increased in a remarkable way with the use of ECMO, but the drecrease in Carbodioxide-arterial-pressure was the most notable result. There was just one case related to procedure complications(16.7%).

CONCLUSIONS: ECMO was usefull in the early management after lung transplantation reducing primary lung graft dysfunction and edema, and it resulted to be an effective way of avoiding early postoperative respiratory distress syndrome. VA mode was very usefull for cardiac assistance and reduced the need of vaso-active drugs after transplantation. VVmode was usefull to increase the PaO2 level but most in decreasing the PCO2 level, and made low-volume ventilatory management possible in order to avoid lung injury.

CLINICAL IMPLICATIONS: ECMO is an effective way of treatment for lung graft primary dysfunction, pulmonary edema and avoiding of early respiratory distress syndrome. It helps in the early postoverative management and reduces the need of vaso-active drugs, and it can save the patients from postoperative mortality when it's timely introduced.

DISCLOSURE: The following authors have nothing to disclose: José González García, Sebastian Peñafiel, Eugenia Libreros Niño, Diana Baquero Velandia, Victor Calvo Medina, Carlos Jordá Aragón, Gabriel Sales Badia, Juan Escrivá, Ángel García Zarza, Juan Pastor Guillem

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