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Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
Preoperative extracorporeal membrane oxygenation is associated with improved outcomes in emergent surgical pulmonary
Hidefumi Nishida1, Ryota Nakamura2, Rihito Tamaki2
1Department of Cardiovascular Surgery, St.Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-0044, Japan. hidefumi226@gmail.com.
Objectives:
The impact of preoperative veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support on outcomes of emergent pulmonary embolectomy for acute pulmonary embolism (PE) remains unclear. This study evaluated the safety and efficacy of preoperative VA-ECMO in patients undergoing emergent surgical embolectomy for high-risk PE.
Methods:
Between December 2007 and September 2025, 38 consecutive patients underwent emergent pulmonary embolectomy for acute PE. Patients were divided into two groups: without preoperative VA-ECMO (Group A, n = 17) and with preoperative VA-ECMO (Group B, n = 21). The primary outcome was a composite of in-hospital mortality and cardiopulmonary arrest (CPA) during anesthesia induction. Secondary outcomes included postoperative complications and long-term survival. Kaplan-Meier analysis was used to compare survival.
Results:
Baseline characteristics were comparable between groups. Four patients in Group A (23.5%) experienced the primary outcome versus none in Group B (0%, p = 0.032). In-hospital mortality was 17.7% in Group A versus 0% in Group B (p = 0.081). Postoperative complications were similar between groups. The mean follow-up period was 55.0 ± 50.1 months. Five-year overall survival was significantly lower in Group A (62.4%) than in Group B (94.4%, log-rank p = 0.012).
Conclusions:
Preoperative VA-ECMO support was safe, and was associated with a lower incidence of hemodynamic collapse during anesthesia induction and better early and long-term survival. Consideration of preoperative VA-ECMO support should be given to improve early and long-term survival.
