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Extracorporeal Membrane Oxygenation Versus Off-pump Technique in Lung Transplantation: A Meta-analysis With
Felipe S Passos1, Maria Clara Carvalho E Silva2, Fabiano Taranto de O Rodrigues2
1Department of Thoracic Surgery, MaterDei Hospital, Salvador, Brazil.
Transplantation
|October 25, 2025
Summary
Extracorporeal membrane oxygenation (ECMO) use in lung transplants is linked to worse early survival and outcomes. However, ECMO remains vital for high-risk individuals, requiring better patient selection and standardized care protocols.
Area of Science:
- Cardiovascular Medicine
- Thoracic Surgery
- Critical Care Medicine
Background:
- Extracorporeal membrane oxygenation (ECMO) is a critical intraoperative support in lung transplantation, especially for high-risk patients.
- Its benefits, including controlled reperfusion and hemodynamic stabilization, are theoretically advantageous.
- However, its impact on postoperative outcomes versus off-pump techniques is debated.
Purpose of the Study:
- To systematically evaluate and compare the evidence on ECMO versus off-pump approaches in lung transplantation.
- To analyze the impact of ECMO on overall survival and key secondary outcomes.
Main Methods:
- A systematic review of three databases was conducted.
- Primary outcome: overall survival. Secondary outcomes: time to extubation, ICU and hospital length of stay (LOS), primary graft dysfunction (PGD), and renal replacement therapy (RRT).
- Statistical analyses included hazard ratios, odds ratios, mean differences, and sensitivity analyses, with subgroup analysis for planned vs. unplanned ECMO.
Main Results:
- Six retrospective studies involving 1008 patients were analyzed.
- ECMO was associated with significantly lower overall survival (HR 1.555, P=0.007).
- ECMO also led to longer time until extubation (MD 1.24 d), longer ICU LOS (MD 2.40 d), longer hospital LOS (MD 3.61 d), and higher incidence of PGD on postoperative day 3 (OR 2.18, P=0.002). No significant difference in RRT was found (P=0.054). Landmark analysis indicated poorer survival within the first 6 months for ECMO patients.
Conclusions:
- ECMO use in lung transplantation is associated with poorer early survival and adverse postoperative outcomes.
- Despite these risks, ECMO remains indispensable for managing high-risk lung transplant recipients.
- Optimized patient selection and standardized ECMO management protocols are crucial to mitigate risks and improve outcomes.
