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Franco Valenza Department of Pathophysiology and Transplantation Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico New perspectives in ECMO 2012.

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Presentation on theme: "Franco Valenza Department of Pathophysiology and Transplantation Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico New perspectives in ECMO 2012."— Presentation transcript:

1 Franco Valenza Department of Pathophysiology and Transplantation Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico New perspectives in ECMO 2012 ECMO and lung transplant program

2 No conflict of interest New perspectives in ECMO 2012 ECMO and lung transplant program

3 New perspectives in ECMO 2012 ECMO and lung transplant program Conventional Un-conventional

4 ECMO - Bridge ECMO - PGD ECMO - Support Conventional

5 ECMO - Bridge ECMO - PGD ECMO - Support beforeduringafter Lung Transplantation

6 ECMO - Support ECMO - Bridge ECMO - PGD Hemodynamics Hypoxia - Hypercapnia Anticoagulation

7 Wen-Je, Artifical Organs (2001); 25(8):607

8 Bittner, Eur J Cardio Thor Surg (2007); 31: 462

9 Burdett, Inter CardioVasc Thor Surg (2012);15:432

10 ECMOPreIntraPostRBCFFPPLTRedoBleeding 1 Bil Yes VV (6) VVVV (1) 74 2 Bil Yes VV (6) VAVV (2) 21282 3 Bil33 4 20 5 Yes VA32 Yes 6 Bil Yes VV (4) VVVV (1) 881 7 Bil Yes VV (3) VAVV (5) 19282Yes 8 Bil2 9 Yes VA32245Yes 10 Yes VV 11 Yes VA5 12 Yes VV (9) VAVV (1) 28303Yes 13 21 14 1 15 16 Bil36 17 Bil54 18 4 19 20 Ca’ Granda, from 3/2011 to present

11 #RBCFFP ECMO no ECMO 9 11 8 (1-24) 2 (0-3) *0.038 14 ± 13 1 ± 2 *0.004 VA VV 6363 17 ± 13 5 ± 40.171 19 ± 13 4 ± 40.083 VA + bridge VA 3333 22 ± 5 12 ± 180.356 29 ± 1 10 ± 120.057

12 #RBCFFP ECMO no ECMO 9 11 8 (1-24) 2 (0-3) *0.038 14 ± 13 1 ± 2 *0.004 VA VV 6363 17 ± 13 5 ± 40.171 19 ± 13 4 ± 40.083 VA + bridge VA 3333 22 ± 5 12 ± 180.356 29 ± 1 10 ± 120.057

13 ECMO - Bridge ECMO - PGD ECMO - Support

14 ECMO Bridge Lung Transplantation Pub Med search Lang, Transplantation (2012);93:729 Bittner, Ann Thor Surg (2012);94:942

15 ECMO Bridge Lung Transplantation Pub Med search Ambulatory ECMO bridge Early vs. Late Awake vs.Intubated

16 ECMO - Bridge ECMO - Support ECMO - PGD

17 Postoperative “treatment” tool Oto, Ann Thor Surg (2004);78:1230

18 Low perfusion pressure Bhabra, Ann Thor Surg 1996;61:1631 Bhabra, Ann Thor Surg 1998;65:187 Pierre, J Thorac Cardiovasc Surg 1998;116:932 Clark, 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

19 McILwain, Lab Invest (2010);90:128

20 MCP-1CXCL-10 IL-8 Control BD Ischemia Graft Relative expression * * * HMGB-1 * Valenza, un published Control BD Ischemia Graft

21 Valenza, un published

22 New perspectives in ECMO 2012 ECMO and lung transplant program Conventional Un-conventional

23 ECMO - Bridge ECMO - PGD ECMO - Support RECIPIENT

24 ECMO - Bridge ECMO - PGD ECMO - Support RECIPIENT reverse - ECMO LUNG DONOR

25 reverse - ECMO Ex-Vivo Lung Perfusion (EVLP)

26 Cypel, NEJM (2011);364:1431

27 * Valenza, Transpl Proc (2012); 44:1826-9

28 ECMO - Bridge ECMO - PGD ECMO - Support RECIPIENT donor - ECMO reverse - ECMO LUNG DONOR

29 Lung Harvest Transplantation BRAIN DEATH Maastricht III CARDIAC DEATH EVLP Maastricht II ECMO Refractory cardiogenic shock ECMO Maastricht VI Liver OLTX Rat Lungs

30 …. in conclusion LUNG DONOR RECIPIENT Bridge Support PGD EVLP DCD No way I’m gonna stay with-out ECMO!

31 …. thanks for your attention!

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