To evaluate the effect of extracorporeal membrane oxygenation (ECMO) in the perioperative period of lung transplantation.

The clinical data of patients transplanted in the Lung Transplantation Center of Wuxi People′s Hospital with perioperative application of ECMO were analyzed retrospectively. A total of 390 lung transplant recipients receiving ECMO during the perioperative phase from January 2015 to December 2019 were selected as subjects. The 390 recipients were divided into V-A group (n=244 ) and V-V group (n=146), and the postoperative applied ECMO recipients were grouped into unextended group (≤72 h) and extended group (>72 h) based on whether the postoperative ECMO support time was >72 h, and recipients in extended group (>72 h) were divided into V-A extended group and V-V extended group. Clinical data were collected such as sex, age, primary disease, mode of surgery (double or single lung), ECMO start time, ECMO support mode (V-A or V-V), peroperative ECMO support time, and withdrawal. Groups meeting normal distribution measurements were compared using the independent sample t test. Non-normal distribution measurement data between groups were compared using Mann-Whitney U test. Count data between groups were compared using the chi-square test or Fisher exact probability method. The 90 d survival curves of lung transplant recipients supported by ECMO were estimated using Kaplan-Meier method, and cumulative survival comparisons were performed using log-rank test. A P value less than 0.05 was considered statistically significant.

Year distribution of 390 recipients: 32 in 2015, 77 in 2016, 87 in 2017, 97 in 2018, and 97 in 2019. Statistically significant difference was found in the proportion of idiopathic pulmonary hypertension in the primary disease of recipients in the V-A group and V-V group (χ²=12.614, P<0.05), and none of the remaining general data were statistically significant (all P>0.05). When the recipients with idiopathic pulmonary arterial hypertention were removed, the removal rates of ECMO of V-A group and V-V group were 211/224 and 137/146, and there was no statistically significant (χ²=0.021, P>0.05). There were 274 patients in 390 perioperative ECMO recipients received post-operative ECMO support, including 230 in the unextended group and 44 in the extended group. The cumulative survival rates of 30 d, 60 d, and 90 d in the unextended group were 90.9%, 86.5%, and 77.4%, respectively, all significantly higher than the extended group (75.0%, 70.5%, and 59.1%) and were statistically significant (χ²=7.840, P<0.05) . The extended group was divided into 26 in the V-A extended group and 18 in the V-V extended group, with no statistically significant difference in cumulative survival at 30 d, 60 d and 90 d between the two groups (χ²=0.654, P>0.05).

ECMO plays an important role in the perioperative period of lung transplantation. V-V catheterization is performed with small trauma, and V-V ECMO mode is more suitable for patients without severe ventricular dysfunction. Patients with idiopathic pulmonary hypertension should choose V-A ECMO mode. Patients with extended postoperative ECMO support time had worse prognosis than unextended patients.