Analysis Of Factors Associated With Intraoperative Extracorporeal Membrane Oxygenation Support In Patients Undergoing Single Lung Transplantation

ObjectiveIn this study,we hypothesized that there are some preoperative variables that may help clinical decision-making when considering whether patients with single lung transplantation need ECMO support.In this study,we analyzed the epidemiological and clinical characteristics of patients with single lung transplantation in our center,tried to determine the factors related to intraoperative ECMO support in patients with single lung transplantation,and to evaluate the postoperative recovery of patients with single lung transplantation after ECMO support.MethodsA retrospective analysis of patients who underwent single lung transplantation in the First Affiliated Hospital of Guangzhou Medical University from January 1,2016 to February 28,2020.Patients were divided into two groups according to whether they received or did not receive ECMO treatment during the operation.Collect and analyze the demographic characteristics and clinical variables of the two groups of patients.Multivariate logistic regression was used to analyze the independent factors related to extracorporeal membrane oxygenation support during lung transplantation.ResultsThis study finally included 110 patients undergoing single lung transplantation.83patients completed the operation safely and successfully without ECMO support,and 27patients needed ECMO support during the operation and finally completed the operation.The average age of the included patients was 57.93±10.42 years old.BMI was 20.06±3.27kg/m².There were 97 male patients（88%）and 13 female patients（12%）.108 patients were ASAⅣ（98.2%）),1 patient（0.9%）each of ASAⅢand ASAⅤ.The general information of the two groups of patients was not statistically different in age,gender,BMI,ASA classification,comorbid diseases（P>0.05）.The types of primary diseases of lung transplant patients were different between the two groups（P=0.018）.More patients underwent left lung transplantation in the ECMO group,and more right lung transplantation in the non-ECMO group（P=0.046）.The pulmonary artery pressure（PAP）of the ECMO group was significantly higher than that of the non-ECMO group（P=0.01）.There was no statistical difference between the two groups of pulmonary capillary wedge pressure,pulmonary vascular resistance and total pulmonary vascular resistance（P>0.05）.In SPECT,the non-operative lung perfusion ratio was higher in the non-ECMO group than in the ECMO group（P=0.012）,while the operatie lung perfusion ratio was significantly lower in the ECMO group（P=0.012）.There was no significant difference in blood routine,liver and kidney function,blood gas analysis and left ventricular ejection fraction between the two groups（P>0.05）.A bivariate multivariate logistic regression analysis of various factors before surgery found that（1）the older the patient,the more likely it is to use ECMO support during surgery,and the odds of using ECMO increase by 1.191 times（P=0.003,OR=1.191）;（2）The primary disease that requires lung transplantation is different,and the probability of using ECMO is also different（P=0.011）.Compared with patients with interstitial lung disease,patients with COPD will have less use ECMO support（P=0.003）;（3）The higher the preoperative neutrophil ratio,the greater the chance of using ECMO（P=0.005,OR=1.128）;（4）The higher the preoperative Pa CO₂,the more likely the need for intraoperative With ECMO assistance,each increase in Pa CO₂by one unit increases the probability by 1.183 times（P=0.021,OR=1.183）;（5）The higher the preoperative PAP,the more ECMO assistance is needed during the operation.Each increase in PAP by one unit,the probability will increase 1.130 times（P=0.018,OR=1.183）;（6）The higher the CVP after induction,the more ECMO support is needed during the operation.Each increase in CVP by one unit will increase the probability by 1.292 times（P=0.023,OR=1.292）;（7）The higher the proportion of non-operative lung perfusion,the less likely it is to use ECMO during operation（P=0.018,OR=0.911）.ConclusionsBased on multivariate regression analysis,we found that the age of patients receiving single lung transplantation,the primary disease requiring lung transplantation,preoperative neutrophil ratio,preoperative Pa CO₂,preoperative PAP,post-induction CVP,non-operative lung Perfusion ratio may affect the possibility of intraoperative ECMO support during single lung transplantation.It can help clinicians make decisions during the perioperative period and help optimize resource allocation.