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Ann Thorac Surg 2008;86:410-417. doi:10.1016/j.athoracsur.2008.04.045
© 2008 The Society of Thoracic Surgeons
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Bernhard Flörchinger
Michael Hilker
Leopold Rupprecht
Stephan Hirt
Karsten Wiebe
Christof Schmid
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Original Articles: General Thoracic

Pumpless Extracorporeal Lung Assist: A 10-Year Institutional Experience

Bernhard Flörchinger, MDa,*, Alois Philippa, Alexander Klose, MDa, Michael Hilker, MD, Reinhard Kobuch, MDa, Leopold Rupprecht, MDa, Andreas Keyser, MDa, Thomas Pühler, MDa, Stephan Hirt, MDa, Karsten Wiebe, MDa, Thomas Müller, MDb, Julia Langgartner, MDc, Karla Lehle, PhDa, Christof Schmid, MDa

a Department of Cardiothoracic Surgery, University Hospital, Regensburg, Germany
b Department of Internal Medicine II, University Hospital, Regensburg, Germany
c Department of Internal Medicine I, University Hospital, Regensburg, Germany

Accepted for publication April 7, 2008.

* Address correspondence to Dr Flörchinger, Department of Cardiothoracic Surgery, University Hospital, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany (Email: christof.schmid{at}klinik.uni-regensburg.de).

Presented at the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.

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.






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