Effect Of Extracorporeal Membrane Oxygenation Support On The Duration Of ICU Treatment During Double Lung Transplantation

Objective:Lung transplantation is the ultimate treatment for a variety of end-stage lung diseases,such as chronic obstructive pulmonary disease,idiopathic interstitial pneumonia and pulmonary cystic fibrosis,which can lead to a longer survival and a better quality of life for the recipient.General anesthesia is commonly used in double lung transplantation.After induction of anesthesia,a double lumen endobronchial tube is inserted for mechanical ventilation.For some patients who are more likely to be hypoxemia,hemodynamic instability and pulmonary hypertension before or during operation,extracorporeal membrane oxygenation is usually used for respiratory or circulatory support to facilitate the completion of the lung transplantation,which can even be used for continuous treatment after the lung transplantation.However,there are no relevant comparative studies on the use of extracorporeal membrane oxygenation intraoperatively for further postoperative treatment in intensive care unit.Therefore,this paper aims to investigate the effects of different respiratory support on ICU treatment time during double lung transplantation.Methods:The clinical data of patients who underwent bilateral lung transplantation at the Transplantation Center of the First Affiliated Hospital of Guangzhou Medical University from December 2018 to December 2020 were retrospectively analyzed.All patients’surgical data and follow-up information were registered in detail.The study plan was approved by the Ethics Committee of our hospital.Sixty patients with stable state after operation were selected as the research objects.These patients have lung transplant indications and received clinician recommendations for lung transplant treatment.According to whether the extracorporeal membrane oxygenation（ECMO）was used for post-anesthesia respiratory support,the patients undergoing double lung transplantation were divided into mechanical ventilation group（group C）and ECMO assisted group（group E）.In mechanical ventilation group（group C）,a total of 25 patients were included,with 3 deaths and 2 patients with incomplete data excluded.ECMO assisted group（group E）excluded 2 patients who died,and eventually,a total of 28 patients were included.Among the two groups,the average age of group C was 49.76±15.98 years old,including18 males and 7 females.The mean age of group E was 56.42±12.66 years old,including19 males and 9 females.In group C,22 cases were ASA gradeⅣand 3 cases were gradeⅤ.And in group E,23 cases were ASA gradeⅣ,5 cases were gradeⅤ.The following data were recorded for two groups of double lung transplant recipients:age,gender,Body weight（Body Mass Index,BMI）,ASA classification,preoperative respiratory status,main preoperative diagnosis,preoperative pulmonary perfusion,pulmonary function rating,which include normal lung function,mild,moderate,and severe ventilation dysfunction.The operative time,anesthesia time,intravenous fluid infusion volume,intraoperative blood transfusion volume,albumin infusion volume,plasma,blood loss and urine volume of bilateral lung transplantation recipients in both groups were recorded.Measurement indexes of lung function of patients with bilateral lung transplantation before and one month after lung transplantation were recorded in both groups,which include Forced expiratory volume in First second（FEVL）,Forced vital capacity（FVC）,FEV1/FVC ratio,Peak expiratory flow（PEF）,and Maximal mid-expiratory flow（MMEF75/25）.The results of heart color Doppler ultrasonography before transplantation（T0）,the first day after surgery（T1）,the third day after surgery（T3）,the seventh day after surgery（T7）,and the 30th day after surgery（T30）of patients with bilateral lung transplantation in both groups were recorded.These specific projects include Left ventricular Ejection Fraction（LVEF）,Left ventricular end-diastolic dimension（LVEDD）,and Left ventricular end-systolic dimension（LVESD）,E/A ratio.The hospitalization time,postoperative endotracheal intubation time,ICU treatment time,ECMO assistance time of group E,and hospitalization expenses of the two groups were recorded.Results:A total of 53 patients with double lung transplantation were included in this study,including 25 patients in group C,including 18 male recipients and 7 female recipients.Group E had 28 patients,including 19 male lung transplant recipients and 9 female lung transplant recipients.There were no significant differences in gender,age and BMI between group C and group E（P>0.05）.There was no significant difference in the amount of intravenous fluid infusion,intraoperative albumin infusion and urine volume between the two groups（P>0.05）,operative time,anesthesia time,intraoperative blood loss and intraoperative transfusion of red blood cells and plasma in group C were less than those in group E（P<0.05）.Comparison of lung function before bilateral lung transplantation and one month after lung transplantation between the two groups showed that there was no significant difference in the lung function between group C and group E in FEV₁,FVC,FEV₁/FVC ratio,PEF and MMEF75/25（P>0.05）.There was no significant difference in LVEF,LVEDD,LVESD,E/A ratio between the two groups before surgery（T0）,the 1st day after surgery（T1）,the 3rd day after surgery（T3）,the 7th day after surgery（T7）,and the 30th day after surgery（T30）（P>0.05）.There was no significant difference in length of hospital stay between the two groups（P>0.05）,postoperative endotracheal intubation time,ICU treatment time and hospitalization cost in group C were less than those in group E（P<0.05）.Conclusion:This study preliminarily demonstrated that extracorporeal membrane oxygenation（ECMO）during double lung transplantation extended the duration of treatment in the intensive care unit（ICU）,but it did not affect cardiopulmonary function in the short,postoperative period of 1 month and the length of hospital stay.