PERIOPERATIVE EXTRACORPOREAL MEMBRANE OXYGENATION IN LUNG TRANSPLANTATION : PREDICTIVE CRITERIA.

The use of perioperative ECMO in lung transplantation helps overcome the unforeseen hemodynamic and respiratory instabilities that may occur during this type of surgery. However, no clear criteria are defined to predict the necessity of its application. Being able to anticipate the necessity for perioperative ECMO could enhance patient management, by preemptively avoiding unplanned ECMO and its associated complications. Therefore, we aim to assess whether criteria derived from preoperative echocardiography and right heart catheterization can effectively predict the necessity for ECMO support during lung transplantation. A total of 102 lung transplantations (27% for Pulmonary Fibrosis, 50% for Chronic Obstructive Pulmonary Disease, 10% for Pulmonary arterial hypertension and 13% for Cystic Fibrosis), performed at our center between January 2016 and December 2022, were retrospectively analyzed. Preoperative echocardiographies were reviewed, and qualitative and quantitative criteria were collected, alongside data from pre/perioperative right heart catheterization. Out of the total, 21 lung transplantations were performed under ECMO at our center. Our findings reveal that qualitative criteria derived from echocardiography, such as the presence of Right Ventricular Dysfunction (RVD) or moderate Tricuspid Regurgitation (mTR) are highly associated with the need for perioperative ECMO. In addition, various echocardiographic parameters, including Right Ventricle End-Diastolic Diameter (RVEDD), Tricuspid Annular Plane Systolic Excursion (TAPSE), Pulmonary Velocity Acceleration Time (PVAT), as well as values from perioperative right heart catheterization, such as systolic pulmonary arterial pressure (PAPs) and mean pulmonary arterial pressure (PAPm), were observed to be significantly correlated with the requirement for perioperative ECMO. Using Youden index and logistic regression, we established optimal cut-off values for each of these variables, as well as odds ratios, as indicated in the following table. Our study showed that we could identify patients at risk for unplanned ECMO during lung transplantation using criteria derived from preoperative echocardiography and perioperative right heart catheterization. These at-risk patients could gain from a preventive approach which could involve, for example, a preemptive introduction of ECMO cannula guides. [ABSTRACT FROM AUTHOR]