The comparative impact of central vs. peripheral VA-ECMO cannulation on postoperative graft dysfunction in lung transplantation: a retrospective analysis.

Abstract

Background: Lung transplantation (LTx) is the definitive treatment for end-stage pulmonary diseases, with venoarterial extracorporeal membrane oxygenation (VA-ECMO) used as a common perioperative support. However, it remains unclear if central (cVA-ECMO) or peripheral (pVA-ECMO) cannulation routes yield better outcomes in postoperative prognosis. This study compares the impact of these two cannulation strategies on primary graft dysfunction (PGD) incidence in LTx patients.

Methods: A retrospective analysis was performed on 153 LTx patients supported with VA-ECMO at the Wuxi Lung Transplant Center (January 2019-March 2023). Patients were divided into central (n = 31) and peripheral (n = 91) groups. Data included recipient/donor demographics, preoperative status, and follow-up outcomes. The primary outcome was PGD within 72 h after reperfusion, whereas secondary outcomes included in-hospital mortality, 1-year survival, renal support needs, ventilation duration, intensive care unit (ICU) stay, and biochemical markers.

Results: PGD incidence was significantly higher in the peripheral group, with longer ECMO duration, ventilation, and ICU stay. Central VA-ECMO showed advantages in in-hospital mortality and 1-year survival rates.

Conclusion: Central VA-ECMO cannulation may reduce postoperative complications and improve survival for LTx recipients. Prospective studies are needed to confirm these findings and refine perioperative ECMO management.