Comparison of extracorporeal membrane oxygenation versus cardiopulmonary bypass for lung transplantation

Objective: This study compared differences in patient outcomes and operative parameters for extracorporeal membrane oxygenation (ECMO) versus cardiopulmonary bypass (CPB) in patients undergoing lung transplants. Methods: Between January 1, 2008, and July 13, 2013, 316 patients underwent lung transplants at our institution, 102 requiring intraoperative mechanical cardiopulmonary support (CPB, n = 55; ECMO, n = 47). We evaluated survival, blood product transfusions, bleeding complications, graft dysfunction, and rejection. Results: Intraoperatively, the CPB group required more cell saver volume (1123 +/- 701 vs 814 +/- 826 mL; P = .043), fresh-frozen plasma (3.64 +/- 5.0 vs 1.51 +/- 3.2 units; P = .014), platelets (1.38 +/- 1.6 vs 0.43 +/- 1.25 units; P = .001), and cryoprecipitate (4.89 +/- 6.3 vs 0.85 +/- 2.8 units; P < .001) than the ECMO group. Post-operatively, the CPB group received more platelets (1.09 +/- 2.6 vs 0.13 +/- 0.39 units; P = .013) and was more likely to have bleeding (15 [27.3%] vs 3 [6.4%]; P = .006) and reoperation (21 [38.2%] vs 7 [14.9%]; P = .009]. The CPB group had higher rates of primary graft dysfunction at 24 and 72 hours (41 [74.5%] vs 23 [48.9%]; P = .008; and 42 [76.4%] vs 26 [56.5%]; P = .034; respectively). There were no differences in 30-day and 1-year survivals. Conclusions: Relative to CPB, the ECMO group required fewer transfusions and had less bleeding, fewer reoperations, and less primary graft dysfunction. There were no statistically significant survival differences at 30 days or 1 year.