Pumpless Extracorporeal Lung Assist: A 10-Year Institutional Experience

• Published in: The Annals of thoracic surgery Vol. 86; no. 2; pp. 410 - 417
• Main Authors: Flörchinger, Bernhard, MD, Philipp, Alois, Klose, Alexander, MD, Hilker, Michael, MD, Kobuch, Reinhard, MD, Rupprecht, Leopold, MD, Keyser, Andreas, MD, Pühler, Thomas, MD, Hirt, Stephan, MD, Wiebe, Karsten, MD, Müller, Thomas, MD, Langgartner, Julia, MD, Lehle, Karla, PhD, Schmid, Christof, MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.08.2008
• Subjects: Adolescent; Adult; Aged; Cardiac Output, Low - epidemiology; Cardiothoracic Surgery; Child; Female; Hemodynamics; Humans; Hypercapnia - therapy; Hypocapnia - therapy; Length of Stay; Male; Middle Aged; Multiple Organ Failure - epidemiology; Pulmonary Gas Exchange; Respiratory Distress Syndrome, Adult - therapy; Respiratory Therapy - methods; Surgery; 11; 25
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2008.04.045

Background Pumpless extracorporeal lung assist (PECLA) was developed to support pulmonary function in patients with severe respiratory insufficiency. Methods Since 1996, 159 patients with an age ranging from 7 to 78 years were provided with a PECLA system. Fifteen patients were referred to us by air or ground transport after insertion of the system in a peripheral hospital. Results Main underlying lung diseases were acute respiratory distress syndrome (70.4%) and pneumonia (28.3%). Pumpless extracorporeal lung assist lasted for 0.1 to 33 days, mean 7.0 ± 6.2 days; cumulative experience was greater than 1,300 days. Successful weaning and survival to hospital discharge was achieved in 33.1% of patients after a mean PECLA support of 8.5 ± 6.3 days. During PECLA therapy, 48.7% of patients died, mainly as a result of multiorgan failure after a mean interval of 4.8 ± 5.1 days. Inability to stabilize pulmonary function was noted in 3% of patients only. After PECLA, 30-day mortality was 13.6%. In a subgroup analysis, best outcome was obtained in patients after trauma. Conclusions Pumpless extracorporeal lung assist is a simple and efficient method to support patients with deteriorating gas exchange for prolonged periods to allow the lung protective ventilation and transportation. Best indication for use of PECLA is severe hypercapnia and moderate hypoxia.