Incidence and Risk Factors for Early Major Neurologic Complications in Lung Transplantation: From Restrictive Cardiopulmonary Bypass to ECMO by Criteria
Vincent Duchesne, Alex Moore, Etienne Revelly, Charles Overbeek, Cédrick Zaouter, Mathilde Fortin, Basil S. Nasir, Pasquale Ferraro, Moishe Liberman, Stephan WilliamsBackground.
Intraoperative hemodynamic instability and hypoxemia may contribute to early major neurologic complications (EMNC) following lung transplantation. Mechanical circulatory support can mitigate cerebral hypoperfusion, but cardiopulmonary bypass (CPB) is an independent risk factor for EMNC. This study examines the incidence of EMNC transitioning from a restrictive CPB strategy to criteria-based use of extracorporeal membrane oxygenation (ECMO-BC).
Methods.
We conducted a single-center retrospective cohort study on 389 lung transplant recipients comparing patients managed with restrictive CPB (PRE-ECMO, 2012–2017, n = 288) to those managed with criteria-based ECMO (ECMO-BC, 2022–2024, n = 101). The incidence of EMNC was compared between groups.
Results.
EMNC occurred in 29 of 280 patients in the PRE-ECMO group and in 5 of 101 patients in the ECMO-BC group (10% versus 5%;
Conclusions.
Transition to ECMO-BC was associated with lower EMNC events and fewer ischemic strokes, but increased intraoperative blood loss and worse early graft function, generating hypotheses for prospective studies that define optimal ECMO indications in lung transplantation.