Awake Extracorporeal Membrane Oxygenation as Bridge to Lung Transplantation: A 9-Year Experience

Abstract

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.

Bridging to lung transplantation with extracorporeal circulatory support: when or when not?

“…However, despite this improvement, the mortality rate for waitlist patients with acute end-stage exacerbations remains as high as 50% (4,5). The waitlist time for such individuals (median of 12 days) is heavily influenced by blood type, body size, and antibodies.…”

Ventilatory and Pharmacotherapeutic Strategies for Management of Adult Patients on Extracorporeal Life Support

“…Given the suboptimal posttransplantation outcomes associated with invasive mechanical ventilation, and the advances in extracorporeal support with improving risk profiles, ECLS may be a preferred alternative approach to support these patients. A strategy that combines ECLS with an awake, endotracheally extubated approach is one most likely to avoid complications associated with sedation and invasive mechanical ventilation while facilitating physical therapy to help maintain transplant candidacy . To further maximize the chances of successful physical conditioning, including ambulation, an upper‐body ECLS configuration is often preferred …”

“…A strategy that combines ECLS with an awake, endotracheally extubated approach is one most likely to avoid complications associated with sedation and invasive mechanical ventilation while facilitating physical therapy to help maintain transplant candidacy . To further maximize the chances of successful physical conditioning, including ambulation, an upper‐body ECLS configuration is often preferred …”

“…A strategy that combines ECLS with an awake, endotracheally extubated approach is one most likely to avoid complications associated with sedation and invasive mechanical ventilation while facilitating physical therapy to help maintain transplant candidacy. 12 To further maximize the chances of successful physical conditioning, including ambulation, an upper-body ECLS configuration is often preferred. 12,13 Bridge to Recovery, Ventricular Assist Device, or Heart Transplantation in Patients with Cardiac Failure Several etiologies of cardiac failure are manageable with venoarterial ECLS, including severe refractory cardiogenic shock, extracorporeal cardiopulmonary resuscitation (ECPR) during cardiac arrest, and refractory ventricular arrhythmias ( Table 1).…”

“…12 To further maximize the chances of successful physical conditioning, including ambulation, an upper-body ECLS configuration is often preferred. 12,13 Bridge to Recovery, Ventricular Assist Device, or Heart Transplantation in Patients with Cardiac Failure Several etiologies of cardiac failure are manageable with venoarterial ECLS, including severe refractory cardiogenic shock, extracorporeal cardiopulmonary resuscitation (ECPR) during cardiac arrest, and refractory ventricular arrhythmias ( Table 1). 4 Evidence supporting the use of ECLS for each of these indications is limited, 13 with ECPR often considered as a distinct therapeutic option because the patient population and outcomes differ significantly from those for other indications.…”