Abstract
OBJECTIVES: This study presents the 5-year experience with a more liberal intraoperative extracorporeal membrane oxygenation (ECMO) elective support in patients with pulmonary fibrosis (PF) undergoing lung transplantation (LTx). METHODS: Patients with PF undergoing LTx between January 2012 and January 2025 were included and sub-divided into the period before and after the implementation of a more liberal intraoperative use of ECMO support in January 2020. Outcomes were compared between elective, non-elective, and no intraoperative ECMO in both periods. Previously-identified parameters as decision criteria for elective ECMO were examined. RESULTS: Overall, 422 PF patients underwent LTx, of whom 273 patients were transplanted before 2020 (elective ECMO, n = 52 (19%); non-elective ECMO, n = 30 (11%); no ECMO, n = 191 (70%)) and 149 patients were transplanted since 2020 (elective intraoperative ECMO, n = 98 (66%); non-elective ECMO, n = 12 (8%); no ECMO, n = 39 (26%)). After 2020, elective ECMO was increasingly used in patients with mean pulmonary arterial pressure >50 mmHg and pulmonary vascular resistance >9.4 WU. However, 8% were not identified based on these parameters and still required non-elective ECMO. Comparing pre- and post-2020, primary graft dysfunction (PGD) grade 3 72 h post-transplant between elective (17% vs 3%, P = .002), non-elective (38% vs 0%, P = .016), and no ECMO (12% vs 3%, P = .078) was significant reduced. One-year graft survival in elective (88.5% vs 95.6%), non-elective (70% vs 91.7%), and no ECMO (92.7% vs 94.9%) showed a trend towards improved survival. CONCLUSIONS: The use of a more liberal, elective intraoperative ECMO support in patients with PF led to an improvement of PGD prevalence and survival early after lung transplantation.