Intraoperative use of extracorporeal CO2 removal (ECCO2R) and emergency ECMO requirement in patients undergoing lung transplant: a case-matched cohort retrospective study

Franco Ruberto; Francesco Alessandri; Mario Piazzolla; Veronica Zullino; Katia Bruno; Paola Celli; Daniele Diso; Federico Venuta; Federico Bilotta; Francesco Pugliese

doi:10.1186/s44158-022-00050-x

Intraoperative use of extracorporeal CO₂ removal (ECCO₂R) and emergency ECMO requirement in patients undergoing lung transplant: a case-matched cohort retrospective study

J Anesth Analg Crit Care. 2022 May 24;2(1):22. doi: 10.1186/s44158-022-00050-x.

Affiliations

¹ Department of General and Specialistic Surgery "Paride Stefanini", "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
² Department of General and Specialistic Surgery "Paride Stefanini", "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. mario.piazzolla@uniroma1.it.

Abstract

Background: The use of extracorporeal carbon dioxide removal (ECCO₂R) is less invasive than extracorporeal membrane oxygenation (ECMO), and intraoperative control of gas exchange could be feasible. The aim of this study in intermediate intraoperative severity patients undergoing LT was to assess the role of intraoperative ECCO₂R on emergency ECMO requirement in patients.

Methods: Thirty-eight consecutive patients undergoing lung transplantation (LT) with "intermediate" intraoperative severity in the intervals 2007 to 2010 or 2011 to 2014 were analyzed as historical comparison of case-matched cohort retrospective study. The "intermediate" intraoperative severity was defined as the development of intraoperative severe respiratory acidosis with maintained oxygenation function (i.e., pH <7.25, PaCO₂ >60 mmHg, and PaO₂/FiO₂ >150), not associated with hemodynamic instability. Of these 38 patients, twenty-three patients were treated in the 2007-2010 interval by receiving "standard intraoperative treatment," while 15 patients were treated in the 2011-2014 interval by receiving "standard intraoperative treatment + ECCO₂R."

Results: ECMO requirement was more frequent among patients that received "standard intraoperative treatment" alone than in those treated with "standard intraoperative treatment + ECCO₂R" (17/23 vs. 3/15; p = 0.004). The use of ECCO₂R improved pH and PaCO₂ while mean pulmonary artery pressure (mPAP) decreased.

Conclusion: In intermediate intraoperative severity patients, the use of ECCO₂R reduces the ECMO requirement.

Keywords: ECCO2R; Hypercapnia; Intraoperative ECLS; Lung transplant.