Extracorporeal membrane oxygenation as a bridge to lung transplantation may not impact overall mortality risk after transplantation: results from a 7-year single-centre experience†

Ius, F.; Natanov, Ruslan; Salman, J.; Kuehn, C.; Sommer, W.; Avşar, M.; Siemeni, T.; Bobylev, D.; Poyanmehr, Reza; Boethig, Dietmar; Optenhoefel, Joerg; Schwerk, Nicolaus; Haverich, Axel; Warnecke, G.; Tudorache, I.

doi:10.1093/ejcts/ezy036

Cited by 37 publications

(34 citation statements)

References 19 publications

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“…Extracorporeal support has been used as a bridge to LT in many centers around the world, especially in North America and Europe 5‐23 . The prognosis of bridge to lung transplantation (BTT) patients varied greatly in different studies.…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal membrane oxygenation as a bridge vs. non‐bridging for lung transplantation: A systematic review and meta‐analysis

Wan

Bian

et al. 2020

Clinical Transplantation

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Whether extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (BTT) can achieve a similar survival to non‐BTT remains controversial. We conducted this meta‐analysis to compare the outcomes between ECMO BTT and non‐BTT to facilitate better clinical decision‐making. Seven databases were searched for eligible studies comparing ECMO BTT and non‐BTT. The primary endpoints included survival, intraoperative indicators, postoperative hospitalization indicators, and postoperative complications. Nineteen studies (involving 7061 participants) were included in the final analysis. The outcomes of overall survival, overall survival rate, graft survival rate, in‐hospital mortality, postoperative hospital days, postoperative intensive care unit days, postoperative ventilation time, blood transfusion volume, and postoperative complications were all better in the non‐BTT group. The total mortality in ECMO bridging was 23.03%, in which the top five causes of death were right heart failure (8.03%), multiple organ failure (7.03%), bleeding (not cranial) (4.67%), cranial bleeding (3.15%), and sepsis (2.90%). In summary, Non‐BTT is associated with better survival and fewer complications compared to BTT. When ECMO may be the only option, the patient and medical team need to realize the increased risk of ECMO by complications and survival.

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Section: Introductionmentioning

confidence: 99%

Extracorporeal membrane oxygenation as a bridge vs. non‐bridging for lung transplantation: A systematic review and meta‐analysis

Wan

Bian

et al. 2020

Clinical Transplantation

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“…As far as possible, "awake" ECMO strategies should be used (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Awake VV ECMO is used to prevent sedation and invasive mechanical ventilatory support to protect respiratory muscles and facilitate active mobilization (24). In addition to early mobilization, normal eating and drinking are important for coping with psychological and physiological problems.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation as a bridge to lung transplantation in a Turkish lung transplantation program: our initial experience

et al. 2020

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Lung transplantation is a life-saving treatment for patients with end-stage lung disease. Although the number of lung transplants has increased over the years, the number of available donor lungs has not increased at the same rate, leading to the death of transplant candidates on waiting lists. In this paper, we presented our initial experience with the use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation. Between December 2016 and August 2018, we retrospectively reviewed the use of ECMO as a bridge to lung transplantation. Thirteen patients underwent preparative ECMO for bridging to lung transplantation, and seven patients successfully underwent bridging to lung transplantation. The average age of the patients was 45.7 years (range, 19-62 years). The ECMO support period lasted 3-55 days (mean, 18.7 days; median, 13 days). In seven patients, bridging to lung transplantation was performed successfully. The mean age of patients was 49.8 years (range 42-62). Bridging time was 3-55 days (mean, 19 days; median, 13 days). Two patients died in the early postoperative period. Five patients survived until discharge from the hospital. One-year survival was achieved in four patients. ECMO can be used safely for a long time to meet the physiological needs of critically ill patients. The use of ECMO as a bridge to lung transplantation is an acceptable treatment option to reduce the number of deaths on the waiting list. Despite the successful results achieved, this approach still involves risks and complications.

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“…In addition, use of ECMO rather than cardiopulmonary bypass might also have contributed to a lower incidence of bleeding. Lung transplantation using cardiopulmonary bypass has been associated with an increased risk of bleeding when compared to ECMO .…”

Section: Discussionmentioning

confidence: 99%

Risk factors for early bleeding complications after lung transplantation – a retrospective cohort study

et al. 2019

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Risk factors for early bleeding complications after lung transplantation are not well described. Our aim was to evaluate coagulation test results and the use of extracorporeal membrane oxygenation as risk factors for bleeding after lung transplantation. We analyzed a single-center cohort of bilateral lung transplants between January 2009 and August 2015. Predictors of severe postoperative bleeding (bleeding requiring reoperation within 48 h of transplantation) were assessed using multivariable logistic regression. The effect of bleeding on survival was assessed using a Cox proportionalhazards model. Twenty-nine (4.5%) of 641 patients experienced severe postoperative bleeding. Postoperative fibrinogen levels (OR = 0.99, 95% CI 0.98-0.995, P = 0.001; per mg/dl increase) and pre-and postoperative use of extracorporeal membrane oxygenation (OR = 14.41% 95% CI 5.4-40.19, P < 0.001 and OR = 4.25, 95% CI 1.0-11.09, P = 0.002, respectively) were associated with an increased risk of severe postoperative bleeding. Severe postoperative bleeding was associated with decreased survival within 60 days after transplantation (adjusted HR = 5.73, 95% CI 2.52-13.02, P < 0.001). Low postoperative fibrinogen levels, and pre-and postoperative use of extracorporeal membrane oxygenation were risk factors for bleeding after lung transplantation.

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Extracorporeal membrane oxygenation as a bridge to lung transplantation may not impact overall mortality risk after transplantation: results from a 7-year single-centre experience†

Abstract: If applied in selected patients in a high-volume centre, pretransplant ECMO as a bridge to transplantation results in impaired, but still high in-hospital, survival and does not impact graft survival.

Cited by 37 publications

References 19 publications

Extracorporeal membrane oxygenation as a bridge vs. non‐bridging for lung transplantation: A systematic review and meta‐analysis

Extracorporeal membrane oxygenation as a bridge vs. non‐bridging for lung transplantation: A systematic review and meta‐analysis

Extracorporeal membrane oxygenation as a bridge to lung transplantation in a Turkish lung transplantation program: our initial experience

Risk factors for early bleeding complications after lung transplantation – a retrospective cohort study

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