franco valenza department of pathophysiology and transplantation
DESCRIPTION
New perspectives in ECMO 2012 ECMO and lung transplant program. Franco Valenza Department of Pathophysiology and Transplantation Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico. New perspectives in ECMO 2012 ECMO and lung transplant program. No conflict of interest. - PowerPoint PPT PresentationTRANSCRIPT
Franco Valenza
Department of Pathophysiology and Transplantation
Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
New perspectives in ECMO 2012
ECMO and lung transplant program
No conflict of interest
New perspectives in ECMO 2012
ECMO and lung transplant program
New perspectives in ECMO 2012
ECMO and lung transplant program
Conventional
Un-conventional
ECMO - Bridge ECMO - PGDECMO - Support
Conventional
ECMO - Bridge ECMO - PGDECMO - Support
before during after
Lung Transplantation
ECMO - SupportECMO - Bridge ECMO - PGD
Hemodynamics
Hypoxia - Hypercapnia
Anticoagulation
Wen-Je, Artifical Organs (2001); 25(8):607
Bittner, Eur J Cardio Thor Surg (2007); 31: 462
Burdett, Inter CardioVasc Thor Surg (2012);15:432
ECMO Pre Intra Post RBC FFP PLT Redo Bleeding
1 Bil Yes VV (6) VV VV (1) 7 4
2 Bil Yes VV (6) VA VV (2) 21 28 2
3 Bil 3 3
4 2 0
5 Bil Yes VA 3 2 Yes
6 Bil Yes VV (4) VV VV (1) 8 8 1
7 Bil Yes VV (3) VA VV (5) 19 28 2 Yes Yes
8 Bil 2
9 Bil Yes VA 32 24 5 Yes
10 Yes VV
11 Yes VA 5
12 Yes VV (9) VA VV (1) 28 30 3 Yes
13 2 1
14 1
15
16 Bil 3 6
17 Bil 5 4
18 4
19
20
Ca’ Granda, from 3/2011 to present
# RBC FFP
ECMOno ECMO
911
8 (1-24)2 (0-3) * 0.038
14 ± 131 ± 2 * 0.004
VAVV
63
17 ± 135 ± 4 0.171
19 ± 134 ± 4 0.083
VA + bridgeVA
33
22 ± 512 ± 18 0.356
29 ± 110 ± 12 0.057
# RBC FFP
ECMOno ECMO
911
8 (1-24)2 (0-3) * 0.038
14 ± 131 ± 2 * 0.004
VAVV
63
17 ± 135 ± 4 0.171
19 ± 134 ± 4 0.083
VA + bridgeVA
33
22 ± 512 ± 18 0.356
29 ± 110 ± 12 0.057
ECMO - Bridge ECMO - PGDECMO - Support
Year
1990 1995 2000 2005 2010
n. o
f re
fere
nce
s
0
5
10
15
20
ECMO Bridge Lung TransplantationPub Med search
Lang, Transplantation (2012);93:729Bittner, Ann Thor Surg (2012);94:942
Year
1990 1995 2000 2005 2010
n. o
f re
fere
nce
s
0
5
10
15
20
ECMO Bridge Lung TransplantationPub Med search
Ambulatory ECMO bridge
Early vs. Late
Awake vs.Intubated
ECMO - Bridge ECMO - Support ECMO - PGD
Postoperative “treatment” tool
Oto, Ann Thor Surg (2004);78:1230
Low perfusion pressure
Bhabra, Ann Thor Surg 1996;61:1631Bhabra, Ann Thor Surg 1998;65:187
Pierre, J Thorac Cardiovasc Surg 1998;116:932Clark, J Thorac Cardiovasc Surg 1998;115:1335
Halldorsson, J Thorac Cardiovasc Surg 1998;115:415
De Perrot, J Thorac Cardiovasc Surg 2002;124:1137 Crimi, Am J respir Crit Care Med 2005;174:178
Chiang, Resuscitation 2008;79:147
Protective ventilation
Valenza, Organ Tissue & Cells (2012)
Intraoperative “prevention” tool
McILwain, Lab Invest (2010);90:128
0
10
20
30
40
50
60
70
MCP-1
0
1
2
3
4
CXCL-10
0
2
4
6
8
10
12
14
16
18
20
IL-8
Control BD Ischemia Graft
Rel
ativ
e ex
pre
ssio
n
*
*
*
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
HMGB-1
*
Valenza, un published
Control BD Ischemia Graft
Control BD Ischemia Graft Control BD Ischemia Graft
Valenza, un published
New perspectives in ECMO 2012
ECMO and lung transplant program
Conventional
Un-conventional
ECMO - Bridge ECMO - PGDECMO - Support
RECIPIENT
ECMO - Bridge ECMO - PGDECMO - Support
RECIPIENT
reverse - ECMO
LUNG DONOR
reverse - ECMOEx-Vivo Lung Perfusion (EVLP)
Cypel, NEJM (2011);364:1431
*
Valenza, Transpl Proc (2012); 44:1826-9
ECMO - Bridge ECMO - PGDECMO - Support
RECIPIENT
donor - ECMO
reverse - ECMO
LUNG DONOR
LUNG DONOR
Lung Harvest
Transplantation
BRAIN DEATH
Maastricht III
CARDIAC DEATH
EVLPMaastricht II
ECMO
Refractory cardiogenic shock
ECMOMaastricht VI
Liver OLTX
Rat Lungs
…. in conclusion
LUNG DONOR
RECIPIENTBridge
SupportPGD
EVLPDCD
No way I’m gonna stay with-out ECMO!
…. thanks for your attention!