Original article
General thoracic
Awake Extracorporeal Membrane Oxygenation as Bridge to Lung Transplantation: A 9-Year Experience

https://doi.org/10.1016/j.athoracsur.2016.11.056Get rights and content

Background

Extracorporeal membrane oxygenation (ECMO) is used as a bridge to lung transplantation, but characteristics that influence its success are poorly understood. This large, single-center experience evaluated the implementation and outcomes of ECMO in this setting.

Methods

Data were collected for patients at our institution (New York-Presbyterian Hospital/Columbia University Medical Center in New York) who received ECMO as a bridge to lung transplantation from January 1, 2007 through July 10, 2016. Data were analyzed for demographics, baseline characteristics, survival, and ECMO configuration.

Results

Seventy-two patients received ECMO as a bridge to lung transplantation. Of the 72 patients, 40 (55.6%) underwent the transplantation procedure, 37 (92.5%) survived to discharge, and 21 (84.0%) survived for 2 years. Inotropy or vasopressor support (70% vs 93.8%; p = 0.011), Simplified Acute Physiology Score (26.8 vs 30.5; p = 0.048), and ambulation (80% vs 56.2%; p = 0.030) were significantly different between the patients who underwent lung transplantation and those who did not. Patients with cystic fibrosis were more likely to have a bridge to transplantation than patients with other lung diseases (47.5% vs 25%; p = 0.050). Daily participation in physical therapy was achieved in 50 patients (69.4%).

Conclusions

This study demonstrated favorable survival in patients receiving ECMO as a bridge to lung transplantation and achieved high rates of physical therapy and avoidance of mechanical ventilation while ECMO was used in patients awaiting lung transplantation. With more than half of these patients successfully bridged to lung transplantation, we gained insight into the factors influencing patients’ outcomes, including patient selection, timing of ECMO, and patient management.

Section snippets

Patients

Data were retrospectively collected from medical charts for all patients who received ECMO as a BTT at New York-Presbyterian Hospital/Columbia University Medical Center from January 1, 2007 through July 10, 2016. Patients were identified as having a BTT if they were already on our institution’s lung transplant list before ECMO initiation. No patients underwent ECMO as a “bridge to decision.” Data collected included demographic information, preoperative data, operative variables, complications,

Results

Between January 1, 2007 and July 10, 2016, 72 patients underwent ECMO with the goal of a BTT. The cause of respiratory failure was CF in 27 (37.5%) patients, ILD in 30 (41.7%), and other conditions in the remaining 15 (20.8%), as detailed in Table 1.

The average Simplified Acute Physiology Score II, which is a measure of disease severity for patients admitted to an intensive care unit, was 28.5 ± 12.0, and the average lung allocation score at the time of ECMO placement was 91.2 ± 5.9. Fifty

Comment

Our experience of 72 patients managed with ECMO intended as a BTT is a large, single-center series. During our 9-year experience, our approach to patient selection, timing of ECMO initiation, and configuration choice has evolved and is outlined in our algorithm (Fig 1), with the goal of allocating ECMO in the most effective way to the patients who have the most reasonable chances of undergoing lung transplantation. Our posttransplant 1-year survival rate was 90.3%, which compares favorably with

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Drs Brodie and Bacchetta are co-senior authors.

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