The impact of pre-operative extracorporeal membrane oxygenation support on survival in lung transplantation surgery- ECMO as bridge to transplant

Background Although bridge to lung transplantation (BTT) with extracorporeal membrane oxygenation (ECMO) is increasingly performed, the impact of BTT and its duration on post-transplant outcomes are unclear. Methods We retrospectively reviewed medical records of adult patients who underwent lung or heart-lung transplantation in our institution between January 2008 and December 2018. Data were compared in patients who did (n = 41; BTT) and did not (n = 36; non-BTT) require pre-transplant ECMO support. Data were also compared in patients who underwent short-term (<14 days; n = 21; ST-BTT) and long-term (≥14 days; n = 20; LT-BTT) BTTs. Results Among 77 patients included, 51 (66.2%) were male and median age was 53 years. The median bridging time in the BTT group was 13 days (interquartile range [IQR], 7–19 days). Although simplified acute physiologic score II was significantly higher in the BTT group (median, 35; IQR, 31–49 in BTT group vs. median, 12; IQR, 7–19 in non-BTT group; p<0.001), 1-year (73.2% vs. 80.6%; p = 0.361) and 5-year (61.5% vs. 61.5%; p = 0.765) post-transplant survival rates were comparable in both groups. Comparison of ST- and LT-BTT subgroups showed that 1-year (90.5% vs. 55.0%; p = 0.009) and 5-year (73.0% vs. 48.1%; p = 0.030) post-transplant survival rates were significantly higher in ST-BTT group. In age and sex adjusted model, the LT-BTT was an independent risk factor for 1-year post-transplant mortality (hazard ratio, 3.019; 95% confidence interval, 1.119–8.146; p = 0.029), whereas the ST-BTT was not. Conclusions Despite the severe illness, the BTT group showed favorable post-transplantation outcomes, particularly those bridged for less than 14 days.

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Blood Products Transfusion and Mid-Term Outcomes of Lung Transplanted Patients Under Extracorporeal Membrane Oxygenation Support

Progress in Transplantation ◽

10.1177/1526924818765816 ◽

2018 ◽

Vol 28 (4) ◽

pp. 314-321 ◽

Cited By ~ 6

Author(s):

Tommaso Pettenuzzo ◽

Giulio Faggi ◽

Guido Di Gregorio ◽

Marco Schiavon ◽

Giuseppe Marulli ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Lung Transplantation ◽

Blood Product ◽

Transfusion Rate ◽

Term Survival ◽

Reliable Technique ◽

Off Pump ◽

Membrane Oxygenation ◽

The Impact ◽

Extracorporeal Support

Introduction: Extracorporeal membrane oxygenation (ECMO) is considered a reliable technique in lung transplantation requiring cardiorespiratory support. However, the impact of this technology on blood product transfusion rate and outcomes compared to off-pump lung transplantation has been rarely investigated. Methods: Between January 2012 and June 2015, 52 elective adult lung transplants were performed at our institution. Of these, 15 recipients required intraoperative venoarterial extracorporeal support and 37 did not. We compared blood product consumption and other outcome variables between the 2 groups. Results: We found comparable in-hospital (86.7% vs 97.3%, P = .14) and 6-month (86.7% vs 91.9%, P = .56) survival between patients with and without extracorporeal support, respectively. Survival at 30 days was lower in the ECMO group (86.7% vs 100%, P = .02). Although patients who underwent ECMO received more intraoperative transfusions, postoperative transfusion rate was similar between the 2 groups. The ECMO group experienced longer mechanical ventilation (median 3 vs 2 days, P = .02) and intensive care unit stay (median 7 vs 5 days, P = .02), besides more cardiogenic shock and deep vein thrombosis. However, we observed no difference in other major and minor in-hospital complications and 6-month complications. Conclusions: In our experience, despite the higher need for intraoperative transfusions, lung transplantation performed with ECMO support is comparable to the off-pump procedure as to short-term survival and outcomes.

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Faculty Opinions recommendation of Active rehabilitation and physical therapy during extracorporeal membrane oxygenation while awaiting lung transplantation: a practical approach.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13382984.14750214 ◽

2011 ◽

Author(s):

Alain Vuylsteke ◽

Ivan Wong

Keyword(s):

Physical Therapy ◽

Extracorporeal Membrane Oxygenation ◽

Lung Transplantation ◽

Practical Approach ◽

Membrane Oxygenation ◽

Active Rehabilitation

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10-Year Experience with Postoperatively-Extended Intraoperative Extracorporeal Membrane Oxygenation in Lung Transplantation for Patients with Severe Pulmonary Hypertension

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2021.01.928 ◽

2021 ◽

Vol 40 (4) ◽

pp. S330

Author(s):

M. Franz ◽

K. Aburahma ◽

T. Siemeni ◽

M. Avsar ◽

D. Bobylev ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Extracorporeal Membrane Oxygenation ◽

Lung Transplantation ◽

Severe Pulmonary Hypertension ◽

Membrane Oxygenation

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The impact of extracorporeal membrane oxygenation on cerebral oxygen delivery during cardiac arrest: a case series

Resuscitation Plus ◽

10.1016/j.resplu.2020.100068 ◽

2021 ◽

Vol 5 ◽

pp. 100068

Author(s):

Emma Roellke ◽

Sam Parnia ◽

Jignesh Patel ◽

Steven Friedman ◽

Amanda Mengotto

Keyword(s):

Cardiac Arrest ◽

Extracorporeal Membrane Oxygenation ◽

Oxygen Delivery ◽

Case Series ◽

Cerebral Oxygen ◽

Membrane Oxygenation ◽

The Impact

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CT fatty muscle fraction as a new parameter for muscle quality assessment predicts outcome in venovenous extracorporeal membrane oxygenation

Scientific Reports ◽

10.1038/s41598-020-79495-5 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Anton Faron ◽

Stefan Kreyer ◽

Alois M. Sprinkart ◽

Thomas Muders ◽

Stefan F. Ehrentraut ◽

...

Keyword(s):

Skeletal Muscle ◽

Extracorporeal Membrane Oxygenation ◽

Adverse Outcomes ◽

Muscle Quality ◽

Imaging Biomarker ◽

Survival Prediction ◽

Multivariable Logistic Regression Model ◽

Muscle Area ◽

Membrane Oxygenation ◽

The Impact

AbstractImpaired skeletal muscle quality is a major risk factor for adverse outcomes in acute respiratory failure. However, conventional methods for skeletal muscle assessment are inapplicable in the critical care setting. This study aimed to determine the prognostic value of computed tomography (CT) fatty muscle fraction (FMF) as a biomarker of muscle quality in patients undergoing extracorporeal membrane oxygenation (ECMO). To calculate FMF, paraspinal skeletal muscle area was obtained from clinical CT and separated into areas of fatty and lean muscle based on densitometric thresholds. The cohort was binarized according to median FMF. Patients with high FMF displayed significantly increased 1-year mortality (72.7% versus 55.8%, P = 0.036) on Kaplan–Meier analysis. A multivariable logistic regression model was built to test the impact of FMF on outcome. FMF was identified as a significant predictor of 1-year mortality (hazard ratio per percent FMF, 1.017 [95% confidence interval, 1.002–1.033]; P = 0.031), independent of anthropometric characteristics, Charlson Comorbidity Index, Simplified Acute Physiology Score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction Score, and duration of ECMO support. To conclude, FMF predicted 1-year mortality independently of established clinical prognosticators in ECMO patients and may have the potential to become a new muscle quality imaging biomarker, which is available from clinical CT.

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Reducing Broad Spectrum Antimicrobial Use in Extracorporeal Membrane Oxygenation (ECMO): Reduce AMMO Study

Clinical Infectious Diseases ◽

10.1093/cid/ciab118 ◽

2021 ◽

Author(s):

Aditya Shah ◽

Priya Sampathkumar ◽

Ryan W Stevens ◽

John K Bohman ◽

Brian D Lahr ◽

...

Keyword(s):

Time Series ◽

Extracorporeal Membrane Oxygenation ◽

Broad Spectrum ◽

Antimicrobial Prophylaxis ◽

Current Evidence ◽

Antimicrobial Use ◽

Infection Rates ◽

Interrupted Time Series Analysis ◽

Membrane Oxygenation ◽

The Impact

Abstract Background The use of extracorporeal membrane oxygenation (ECMO) in critically ill adults is increasing. There are currently no guidelines for antimicrobial prophylaxis. We analyzed 7 years of prophylactic antimicrobial use across three time series for patients on ECMO at our institution in the development, improvement, and streamlining of our ECMO antimicrobial prophylaxis protocol. Study design and Methods In this quasi-experimental interrupted time series analysis, we evaluated the impact of an initial ECMO antimicrobial prophylaxis protocol, implemented in 2014, on antimicrobial use and NHSN reportable infection rates. Then, following a revision and streamlining of the protocol in November 2018, we re-evaluated the same metrics. Results Our study population included 338 ICU patients who received ECMO between July 2011 and November 2019. After implementation of the first version of the protocol we did not observe significant changes in antimicrobial use or infection rates in these patients; however, following revision and streamlining of the protocol, we demonstrated a significant reduction in broad spectrum antimicrobial use for prophylaxis in patients on ECMO without any evidence of a compensatory increase in infection rates. Conclusion Our final protocol significantly reduces broad spectrum antimicrobial use for prophylaxis in patients on ECMO. We propose a standard antimicrobial prophylaxis regimen for patients on ECMO based on current evidence and our experience.

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