418: Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation in Severe End Stage Pulmonary Disease

Abstract Background As lung transplantation (LTx) becomes a standard treatment for end-stage lung disease, bridging to LTx with extracorporeal membrane oxygenation (ECMO) is increasing during waiting time, for either rescue treatment or improving ability to rehabilitation before transplant. This study investigated post-operative outcomes in patients bridging to lung transplantation with ECMO, especially those receiving awake ECMO. Methods In this single-center study, we retrospectively reviewed 241 consecutive LTx patients between October 2012 and March 2019. Among them, 65 patients received ECMO support while waiting for LTx; these patients were analyzed according to their awakeness. Multivaribale logistic regression and Cox proportional hazard models were used to analyze variables associated awake strategy and mortality. Results Thirty-three patients (50.7%) were awake during bridging ECMO, and 32 patients (49.2%) were in sedative status. The median age of awake ECMO patients was 59.0 (IQR 54.0-63.0) years, and 63.1% of population was male. There were no significant differences between awake and non-awake ECMO patients with respect to age, comorbidities, APACHE II score, ECMO duration and ECMO blood flow. Awake group have better post-operative outcome in terms of statically shorter post-operative intensive care unit (ICU) length of stay (LOS) (awake vs. non-awake, 6 [4-9.5] vs. 16 [6-22], p = 0.004) and longer ventilator free days (VFDs) (awake vs. non-awake, 24 [11.0-25.0] vs. 0 [0.0-14.5], p = 0.001). Furthermore, the awake ECMO group had a significantly lower six-month mortality rate compared to the non-awake group (18.2% vs. 40.6%, p = 0.045). It was independent predictive factor for ability to gait after LTx ([OR] 4.128, 95% CI 1.094-15.572, p = 0.036). Conclusions Awake ECMO therapy could be useful for high-risk patients waiting for LTx, and might help shorten ICU LOS and improve survival benefit after LTx. Furthermore, awake ECMO was independent predictive factor for postoperative gaiting.

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Long- and short-term clinical impact of awake extracorporeal membrane oxygenation as bridging therapy for lung transplantation

Respiratory Research ◽

10.1186/s12931-021-01905-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Nam Eun Kim ◽

Ala Woo ◽

Song Yee Kim ◽

Ah Young Leem ◽

Youngmok Park ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Lung Transplantation ◽

Lung Disease ◽

Unit Length ◽

Forced Expiratory Volume ◽

Clinical Impact ◽

Short Term ◽

Bridging Therapy ◽

Membrane Oxygenation ◽

End Stage

Abstract Background As lung transplantation (LTx) is becoming a standard treatment for end-stage lung disease, the use of bridging with extracorporeal membrane oxygenation (ECMO) is increasing. We examined the clinical impact of being awake during ECMO as bridging therapy in patients awaiting LTx. Methods In this single-center study, we retrospectively reviewed 241 consecutive LTx patients between October 2012 and March 2019; 64 patients received ECMO support while awaiting LTx. We divided into awake and non-awake groups and compared. Results Twenty-five patients (39.1%) were awake, and 39 (61.0%) were non-awake. The median age of awake patients was 59.0 (interquartile range, 52.5–63.0) years, and 80% of the group was men. The awake group had better post-operative outcomes than the non-awake group: statistically shorter post-operative intensive care unit length of stay [awake vs. non-awake, 6 (4–8.5) vs. 18 (11–36), p < 0.001], longer ventilator free days [awake vs. non-awake, 24 (17–26) vs. 0 (0–15), p < 0.001], and higher gait ability after LTx (awake vs. non-awake, 92% vs. 59%, p = 0.004), leading to higher 6-month and 1-year lung function (forced expiratory volume in 1 s: awake vs. non-awake, 6-month, 77.5% vs. 61%, p = 0.004, 1-year, 75% vs. 57%, p = 0.013). Furthermore, the awake group had significantly lower 6-month and 1-year mortality rates than the non-awake group (6-month 12% vs. 38.5%, p = 0.022, 1-year 24% vs. 53.8%, p = 0.018). Conclusions In patients with end-stage lung disease, considering the long-term and short-term impacts, the awake ECMO strategy could be useful compared with the non-awake ECMO strategy.

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Extracorporeal membrane oxygenation as a bridge to lung transplantation in the United States: An evolving strategy in the management of rapidly advancing pulmonary disease

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2014.08.072 ◽

2015 ◽

Vol 149 (1) ◽

pp. 291-296 ◽

Cited By ~ 69

Author(s):

Awori J. Hayanga ◽

Jonathan Aboagye ◽

Stephen Esper ◽

Norihisa Shigemura ◽

Christian A. Bermudez ◽

...

Keyword(s):

United States ◽

Extracorporeal Membrane Oxygenation ◽

Lung Transplantation ◽

Pulmonary Disease ◽

The United States ◽

Membrane Oxygenation

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Bridge to Lung Transplantation with Veno-Venous Extracorporeal Membrane Oxygenation for End-Stage Lung Disease: A Single Center Experience

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2013.01.553 ◽

2013 ◽

Vol 32 (4) ◽

pp. S219 ◽

Cited By ~ 1

Author(s):

C.F. Evans ◽

Z.N. Kon ◽

B.P. Wehman ◽

M. Gibber ◽

A.T. Iacono ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Lung Transplantation ◽

Lung Disease ◽

Single Center ◽

Membrane Oxygenation ◽

Single Center Experience ◽

End Stage

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Predictors of using extracorporeal membrane oxygenation in lung transplantation

Transplantologiya The Russian Journal of Transplantation ◽

10.23873/2074-0506-2019-11-2-107-115 ◽

2019 ◽

Vol 11 (2) ◽

pp. 107-115

Author(s):

M. Sh. Khubutiya ◽

E. A. Tarabrin ◽

S. V. Zhuravel ◽

V. G. Kotandzhyan ◽

N. A. Karchevskaya ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Extracorporeal Membrane Oxygenation ◽

Lung Transplantation ◽

Definitive Treatment ◽

Systolic Pulmonary Artery Pressure ◽

Membrane Oxygenation ◽

Bilateral Lung ◽

End Stage ◽

High Degree

Rationale. Lung transplantation is the only definitive treatment in end-stage pulmonary disease. Extracorporeal membrane oxygenation (ECMO) has been used during surgery in recent years as a replacement for respiratory function; ECMO, however, has some drawbacks: the presence of an extracorporeal circuit, the need for heparinization, potential thrombogenicity that underlies the risks of developing specific complications that worsen the transplantation prognosis. In this regard, it is relevant to study the factors that make it possible to predict the need in intraoperative ECMO in order to avoid its unjustified use.Purpose. To identify predictors for intraoperative use of ECMO in lung transplantation.Material and methods. The medical records of patients who underwent lung transplantation in the Sklifosovsky Research Institute for Emergency Medicine from May 2011 to July 2017 were retrospectively reviewed. Forty nine bilateral lung transplantations were made where 15 patients (30.6%) had lung transplantation performed without ECMO, and 34 (69.4%) underwent lung transplantation and ECMO. A central veno-arterial connection was used in all patients. The study analyzed various factors of patient condition at baseline and identified the most significant of them that enabled to predict the need of ECMO use at surgery with a high degree of probability, avoiding episodes of gas exchange and hemodynamic impairments, the prolongation of surgery, and, therefore, the graft ischemia time.Results. As assessed in this study, pulmonary hypertension was the only predictor of an increased likelihood of using ECMO. The probability of connection to ECMO statistically significantly increased in the patients with systolic pulmonary artery pressure higher 50 mm Hg (p<0.05).Conclusion. The presence of pulmonary hypertension > 50 mm Hg determines the preventive use of ECMO during lung transplantation, which should reduce the number of uncontrolled emergencies during the main stages of surgical intervention; in all other cases, ECMO should be connected basing either on the pulmonary artery compression test results or when indicated.

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