肺移植と体外式膜型人工肺（ECMO）

Extracorporeal Membrane Oxygenation in Lung Transplantation

体外式膜型人工肺（extracorporeal membrane oxygenation：ECMO）は心肺補助装置である．手術室のみならず集中治療室（ICU）などで使用可能であり，使用用途は幅広い．肺移植においては，肺移植前・肺移植中・肺移植後のすべての局面でECMOが必要となりうる．肺移植をまつ患者への橋渡しとしてのbridge ECMOや，術中の人工心肺にかわる心肺補助，および術後の急性期グラフト機能不全や拒絶，感染などによる呼吸不全状態にECMOが使用されうる．本稿では肺移植とECMOについて，当院での経験をふまえて概説する．

Multiple situations necessitate extracorporeal membrane oxygenation （ECMO） during lung transplantation. ECMO can also be used as a bridge to lung transplantation. We describe five cases in which bridging ECMO was successfully utilized, including three cases of living donor lung transplantation. ECMO can also be used as an alternative to cardiopulmonary bypass for intraoperative support during lung transplantation, and postoperatively, primary graft dysfunction, rejection, and infection can cause reversible respiratory failure which warrants ECMO. It can also be used for patients with pulmonary arterial hypertension in the early postoperative period to help their hearts adjust to new circulation. Eight patients with pulmonary arterial hypertension who underwent lung transplantation at our institution received intraoperative and early postoperative ECMO support and their postoperative courses were uneventful. In this report, we review the indications for ECMO and the type of ECMO required for each of the various issues that can arise during lung transplantation, based on the literature and our experiences.