Off-Pump Bilateral Cadaveric Lung Transplantation Is Associated With Profound Intraoperative Hypothermia

Objectives: Changes in body temperature (BT) during lung transplantation never have been reported. The authors investigated the time-dependent changes in BT during lung transplantation and compared them between off-pump lung transplantation and lung transplantation using extracorporeal membrane oxygenation (ECMO).

Design: A retrospective observational study.

Setting: University hospital.

Participants: Patients who underwent cadaveric lung transplantation (15 bilateral lung transplantation [BLT] and 31 single-lung transplantation [SLT]).

Interventions: None.

Measurements and main results: All patients received multimodal therapy to prevent intraoperative hypothermia, including increased environmental temperature, intravenous fluid warming, and the use of forced-air and circulating water warmers. Data of BT during the surgery were collected, and the time course and the extent of BT decrease during the surgery were analyzed. ECMO support during the surgery was necessary for 66.7% of BLT patients and 35.5% of SLT patients; patient characteristics were comparable between off-pump and ECMO-supported lung transplantation. In patients undergoing off-pump BLT, BT decreased continuously to 32.9°C when reperfusion was completed and gradually recovered thereafter. The decrease in BT was significantly larger during off-pump BLT compared with ECMO-supported BLT (3.5°C±0.5°C compared with 0.6°C±0.5°C, p = 0.002) and was≥3°C in all patients. Patients undergoing off-pump SLT had a similar time trend for their BTs (continuous decrease until reperfusion and subsequent recovery), but the extent of BT decrease was much smaller than that in off-pump BLT patients (1.0°C±0.5°C).

Conclusions: Patients undergoing off-pump BLT were at high risk of profound intraoperative hypothermia despite multimodal preventive therapy.