Clinical application effect of ECMO in lung transplantation for recipients with combined pulmonary fibrosis and emphysema

Objective To investigate the effects of different extracorporeal membrane oxygenation (ECMO) bypass modes on the prognosis of patients with combined pulmonary fibrosis and emphysema (CPFE) during lung transplantation.

Methods A retrospective analysis was conducted on 44 CPFE patients who underwent lung transplantation, and they were divided into the venous-venous ECMO (VV-ECMO) group (30 cases) and the venous-arterial ECMO (VA-ECMO) group (14 cases). The preoperative, intraoperative, postoperative and follow-up related indicators of two groups were compared.

Results Compared with the VV-ECMO group, the patients in the VA-ECMO group were younger, had higher pulmonary artery pressure before surgery, fewer posterolateral incision types, longer operation times, and higher incidence of postoperative bronchopleural fistula (all P<0.05). The pulmonary artery pressure decreased after surgery in both groups, with a greater decrease in the VA-ECMO group (P<0.05). There was no statistically significant difference in postoperative survival rates between the two groups (P>0.05).

Conclusions Both VA-ECMO and VV-ECMO are safe and effective in lung transplant patients with CPFE. The bypass mode has no significant impact on the short and medium-term prognosis of the patients. VA-ECMO is more suitable for patients with higher preoperative pulmonary artery pressure.