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Background <p>Veno-arterial (V-A) and veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) are crucial support modalities during lung transplantation, yet their comparative effectiveness remains unclear.</p> Methods <p>We conducted an 8-year retrospective analysis of 62 lung transplant recipients who received intraoperative ECMO (29&#xa0;V-A, 33&#xa0;V-V). Baseline characteristics, surgical parameters, and clinical outcomes were compared. To address potential selection bias, we employed entropy weighted inverse probability of treatment weighting (IPTW-EW).</p> Results <p>After IPTW-EW adjustment, V-A ECMO was associated with superior hemodynamic and respiratory parameters, including lower systolic pulmonary artery pressure (30 vs. 37 mmHg, <i>p</i> = 0.007), higher arterial oxygen partial pressure (119 vs. 78 mmHg, <i>p</i> = 0.002), and less severe pulmonary edema (Grade 1: 50% vs. 3%, Grade 2: 45% vs. 38%, Grade 3: 5% vs. 59%, <i>p</i> &lt; 0.001). Notably, V-A ECMO demonstrated significantly lower 28-day (5% vs. 29%, <i>p</i> = 0.017) and hospital mortalities (21% vs. 69%, <i>p</i> = 0.035).</p> Conclusions <p>V-A ECMO provides superior pulmonary circulation unloading and is associated with improved survival outcomes compared to V-V ECMO in lung transplantation, suggesting its preferential use when clinically appropriate.</p>

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The superiority of veno-arterial over veno-venous extracorporeal membrane oxygenation for operative support of lung transplantation

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年1月20日

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  • Sen Lu,
  • Pin Wang,
  • Xiao-qin Zhang,
  • Gang Feng,
  • Hong-li He,
  • Yue Chen,
  • Xiao-bo Huang,
  • Chun Pan,
  • Jing-chao Luo

摘要

Background

Veno-arterial (V-A) and veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) are crucial support modalities during lung transplantation, yet their comparative effectiveness remains unclear.

Methods

We conducted an 8-year retrospective analysis of 62 lung transplant recipients who received intraoperative ECMO (29 V-A, 33 V-V). Baseline characteristics, surgical parameters, and clinical outcomes were compared. To address potential selection bias, we employed entropy weighted inverse probability of treatment weighting (IPTW-EW).

Results

After IPTW-EW adjustment, V-A ECMO was associated with superior hemodynamic and respiratory parameters, including lower systolic pulmonary artery pressure (30 vs. 37 mmHg, p = 0.007), higher arterial oxygen partial pressure (119 vs. 78 mmHg, p = 0.002), and less severe pulmonary edema (Grade 1: 50% vs. 3%, Grade 2: 45% vs. 38%, Grade 3: 5% vs. 59%, p < 0.001). Notably, V-A ECMO demonstrated significantly lower 28-day (5% vs. 29%, p = 0.017) and hospital mortalities (21% vs. 69%, p = 0.035).

Conclusions

V-A ECMO provides superior pulmonary circulation unloading and is associated with improved survival outcomes compared to V-V ECMO in lung transplantation, suggesting its preferential use when clinically appropriate.