Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplant: Midterm Outcomes

Bermúdez, C.; Rocha, Rodolfo V.; Zaldonis, D.; Bhama, Jay K.; Crespo, Maria; Shigemura, Norihisa; Pilewski, Joseph M.; Sappington, Penny L.; Boujoukos, Arthur J.; Toyoda, Yoshiya

doi:10.1016/j.athoracsur.2011.04.122

Cited by 155 publications

(155 citation statements)

References 17 publications

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“…In addition, use of lower OI's for entry criteria into clinical studies of pediatric respiratory failure may also be warranted. 6,[10][11][12][13] This threshold OI finding warrants further investigation with larger data sets from multiple centers. Review of the patient EMR had limited capability in calculating OI.…”

Section: Discussionmentioning

confidence: 99%

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Identifying an Oxygenation Index Threshold for Increased Mortality in Acute Respiratory Failure

Hammond

Garcia-Filion²,

Kang

et al. 2017

Respir Care

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Objectives: To examine current oxygenation index (OI) data and outcomes using EMR data to identify a specific OI values associated with outcome. Methods:Retrospective review of electronic medical record (EMR) data for patients age 1 month -20 years mechanically ventilated for >24 hours in the PICU. Serial, average and maximum OI values were calculated. Length of mechanical ventilation, hospital stay and outcome were assessed.Results: OI was calculated on 65 patients from EMR data, of which 6 died (9.2%). The median maximum OI was 10 for all patients, 17 for non-survivors (NS), and 8 for survivors (S), (p=0.14 via Wilcoxon rank-sum test). Odds ratios (OR) indicated 2.1 times increase odds of death (p=.08), 95% confidence interval (0.89-5.03) for each one-percent increase in maximum OI.Average OI OR also revealed 2.1 times increase in odds of death (p=.14), 95% confidence interval (0.77-5.48). ROC analysis indicated a higher discriminate ability for max OI (AUC = 0.68) than average OI (AUC = .58). OI cut points for mortality were established. Mortality was unchanged until max OI >17, for which mortality nearly tripled at a value of 18% versus 6-7% for range 0-17. Conclusions:Serial assessment of OI values may allow creation of alert values for increased mortality risk and aid in development of clinical decision rules. Consideration for escalation of therapies for respiratory failure such as high frequency ventilation or ECMO at lower levels of OI than historically reported may be warranted. This study also helps to validate prior reports that OI is useful as a severity score for clinical research and outcome prediction.

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Section: Discussionmentioning

confidence: 99%

“…In addition, use of lower OI's for entry criteria into clinical studies of pediatric respiratory failure may also be warranted. 6,10,12,13,15 Ongoing evaluation of other parameters of respiratory failure such as the oxygen saturation index may also be obtained from the EMR.…”

Section: Future Directionsmentioning

confidence: 99%

Identifying an Oxygenation Index Threshold for Increased Mortality in Acute Respiratory Failure

Hammond

Garcia-Filion²,

Kang

et al. 2017

Respir Care

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“…[11][12][13][14][15] Early studies demonstrated feasibility and potentially improved outcomes with this ECMO rehabilitation strategy as a bridge to transplantation. 14,16,17 In a single-center study, subjects who were spontaneously breathing while supported with ECMO had better 1-y survival rates post-transplant than did their mechanically ventilated counterparts who were supported with ECMO and proceeded to lung transplantation. 18 While deconditioning, critical illness myopathy, and length of stay for these critically ill patients supported with ECMO as a bridge to lung transplantation may be improved by an ambulatory approach, 14 the economics of this strategy have not been investigated previously.…”

Section: See the Related Editorial On Page 117mentioning

confidence: 99%

Economic Outcomes of Extracorporeal Membrane Oxygenation With and Without Ambulation as a Bridge to Lung Transplantation

et al. 2015

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“…ECMO, a supportive technique of respiratory circulation, is frequently used in emergency treatment of neonatal critical conditions, 5,6) severe myocarditis, 7) ARDS 8) and temporary cardiopulmonary function replacement before and after organ transplantation. 9) In recent years, it is also used in some complex tracheal operations, the treatment of post-traumatic empyema, and some other general thoracic diseases. 10,11) However, there are few reports about using ECMO in removing esophageal stents in patients with complex tracheoesophageal fistulas.…”

Section: Discussionmentioning

confidence: 99%

Application of ECMO to the Treatment of Benign Double Tracheoesophageal Fistula: Report of a Case

Wang

Zhan

et al. 2014

ATCS

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Surgery is necessary for most patients who underwent benign tracheoesophageal fistula, regarding the poor prognosis of the conservative treatment. However, it is hard for patients who suffer the airway obstruction by stent piercing to undergo the operation due to the difficulty of endotracheal intubation. This article presents an extracorporeal membrane oxygenation (ECMO)-assisted surgery to remove the esophageal stent before the routine endotracheal intubation, which can help to perform the operation successfully. Case ReportA 43-year-old woman patient was admitted to our hospital because of postprandial choking cough and shortness of breath for 3 weeks. Six years ago, she received chemotherapy and cervical radiotherapy for B cell lymphoma. Two years ago, a mediastinal lymph node metastasis was found by positron emission tomography (PET)-computed tomography (CT), for which she received mediastinal radiotherapy. After radiotherapy, the patient presented dysphagia, and chest CT scan revealed the presence of esophageal stenosis. The symptoms were relieved after esophageal expansion treatment. The patient presented 1 year ago with choking cough after drinking fluid, and an esophageal fistula, which had a diameter less than 1 cm and located 1.5 cm superior to the tracheal carina, was found by CT scan. To relieve the symptoms, a self-expanding metal stent was implanted. About 3 weeks ago, the patient complained of postprandial choking cough and shortness of breath again. Cervical CT scan in our hospital revealed tracheal obstruction caused by the expanding upper part of esophageal stent compression. Part of the stent pierced into the tracheal cavity in the thoracic entrance level forming a new tracheoesophageal fistula with a diameter of 3 cm. And no heal was found in the original fistula (Fig. 1). The bronchofibroscopic result verified the CT finding. Surgery, including the stent removing, cervical esophagostomy externa, exclusion of the thoracic tracheoesophageal fistulas and Application of ECMO to the Treatment of Benign Double Tracheoesophageal Fistula: Report of a CaseLei Wang, MD, Xiao Ping Xu, MM, Hen Zhang, MM, and Shao Ming Zhang, MD, PhD This report presents the extracorporeal membrane oxygenation (ECMO)-assisted surgical as a treatment of benign double tracheoesophageal fistula. The patient was a 43-yearold woman who presented the airway obstruction for 3 weeks after the esophagus metal stent implantation for the tracheoesophageal fistula 1 year ago. The airway obstruction was due to the expansion and piercing of the metal stent through the upper part of the esophagus into the tracheal cavity. In view of the failure of endotracheal intubation, we finally used ECMO-assisted surgery to remove the stent. And at the same time, cervical esophagostomy externa, exclusion of the thoracic tracheoesophageal fistulas and gastrostomy were performed.

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Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplant: Midterm Outcomes

Cited by 155 publications

References 17 publications

Identifying an Oxygenation Index Threshold for Increased Mortality in Acute Respiratory Failure

Identifying an Oxygenation Index Threshold for Increased Mortality in Acute Respiratory Failure

Economic Outcomes of Extracorporeal Membrane Oxygenation With and Without Ambulation as a Bridge to Lung Transplantation

Application of ECMO to the Treatment of Benign Double Tracheoesophageal Fistula: Report of a Case

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