Yuliya Tipograf1, Michael Salna2, Elizaveta Minko3, Eric L Grogan1, Cara Agerstrand4, Joshua Sonett5, Daniel Brodie4, Matthew Bacchetta6. 1. Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. 2. Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York. 3. Department of Surgery, Columbia University Medical Center, New York, New York. 4. Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Columbia University Medical Center, New York, New York. 5. Section of Thoracic Surgery, Department of Surgery, Columbia Medical Center, New York, New York. 6. Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: matthew.bacchetta@vanderbilt.edu.
Abstract
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (BTT) has become a critical component of caring for patients with end-stage lung disease. This study examined outcomes of patients who received ECMO as a BTT. METHODS: Statistical analysis was performed on data gathered retrospectively from the electronic medical records of adult patients who received ECMO as BTT at Columbia University Medical Center from April 2009 through July 2018. RESULTS: A total of 121 adult patients were placed on ECMO as BTT, and 70 patients (59%) were successfully bridged to lung transplantation. Simplified Acute Physiology Score II, unplanned endotracheal intubation, renal replacement therapy, and cerebrovascular accident were identified as independent predictors of unsuccessful BTT. Ambulation was the only independent predictor of successful BTT (odds ratio, 7.579; 95% confidence interval, 2.158 to 26.615; p = 0.002). Among the 64 patients (91%) who survived to hospital discharge, survival was 88% at 1 year and 83% at 3 years. Propensity matching between BTT and non-BTT lung transplant recipients did not show a significant difference in survival (log-rank = 0.53) despite significant differences in the lung allocation score (median, 92.2 [interquartile range, 89.0 to 94.2] vs 49.6 [interquartile range, 40.6 to 72.3], p < 0.01). CONCLUSIONS: ECMO can be used successfully to bridge patients with end-stage lung disease to lung transplantation. When implemented by an experienced team with adherence to stringent protocols and patient selection, outcomes in BTT patients were comparable to patients who did not receive pretransplant support.
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (BTT) has become a critical component of caring for patients with end-stage lung disease. This study examined outcomes of patients who received ECMO as a BTT. METHODS: Statistical analysis was performed on data gathered retrospectively from the electronic medical records of adult patients who received ECMO as BTT at Columbia University Medical Center from April 2009 through July 2018. RESULTS: A total of 121 adult patients were placed on ECMO as BTT, and 70 patients (59%) were successfully bridged to lung transplantation. Simplified Acute Physiology Score II, unplanned endotracheal intubation, renal replacement therapy, and cerebrovascular accident were identified as independent predictors of unsuccessful BTT. Ambulation was the only independent predictor of successful BTT (odds ratio, 7.579; 95% confidence interval, 2.158 to 26.615; p = 0.002). Among the 64 patients (91%) who survived to hospital discharge, survival was 88% at 1 year and 83% at 3 years. Propensity matching between BTT and non-BTT lung transplant recipients did not show a significant difference in survival (log-rank = 0.53) despite significant differences in the lung allocation score (median, 92.2 [interquartile range, 89.0 to 94.2] vs 49.6 [interquartile range, 40.6 to 72.3], p < 0.01). CONCLUSIONS: ECMO can be used successfully to bridge patients with end-stage lung disease to lung transplantation. When implemented by an experienced team with adherence to stringent protocols and patient selection, outcomes in BTTpatients were comparable to patients who did not receive pretransplant support.
Authors: Alain Combes; Daniel Brodie; Nadia Aissaoui; Thomas Bein; Gilles Capellier; Heidi J Dalton; Jean-Luc Diehl; Stefan Kluge; Daniel F McAuley; Matthieu Schmidt; Arthur S Slutsky; Samir Jaber Journal: Intensive Care Med Date: 2022-08-09 Impact factor: 41.787
Authors: David Furfaro; Erika B Rosenzweig; Lori Shah; Hilary Robbins; Michaela Anderson; Hanyoung Kim; Darryl Abrams; Cara L Agerstrand; Daniel Brodie; Danielle Feldhaus; Joseph Costa; Philippe Lemaitre; Bryan P Stanifer; Frank D'Ovidio; Joshua R Sonett; Selim Arcasoy; Luke Benvenuto Journal: J Heart Lung Transplant Date: 2021-08-25 Impact factor: 13.569
Authors: Darya Rudym; Luke Benvenuto; Joseph Costa; Meghan Aversa; Hilary Robbins; Lori Shah; Hanyoung Kim; Bryan P Stanifer; Joshua Sonett; Frank D'Ovidio; Selim M Arcasoy Journal: Ann Transplant Date: 2020-08-18 Impact factor: 1.530