Extracorporeal membrane oxygenation as a bridge to lung transplantation in the United States: An evolving strategy in the management of rapidly advancing pulmonary disease

Abstract

Short-term survival with the use of extracorporeal membrane oxygenation as a bridge to lung transplantation has significantly improved over the past few years.

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

“…Cystic fibrosis patients had the best survival, with a 56% survival rate at 3 years from the initiation of ECMO. This was contrary to the report by Hayanga and colleagues (25). Toyoda and colleagues (33) reported a 77% success rate in 31 patients who were bridged with ECMO.…”

“…Because old age increases the risk of perioperative mortality, older patients should be approached with caution. The report by Hayanga and colleagues (25) showed that age greater than 35 years was an independent risk factor in patients who were bridged. Nonetheless, a follow-up case report and literature review described a successful transplantation for a 70-year old patient who was bridged with conscious sedation and no mechanical ventilation (26).…”

“…A report on the US trends in bridging outcomes by Hayanga and colleagues (25) showed that in 2000-2002, the 1-year survival rate after ECMO bridging was 25%, which was increased to 74% in 2009-2011. This may be because of improvements in circuit design, better management, or better patient selection (20).…”

Extracorporeal life support for adult cardiopulmonary failure

“…transplantation, but with the improved safety profile of modern ECMO, several groups have demonstrated excellent outcomes with the use of pre-transplant extracorporeal support [27][28][29][30][31]. In some circumstances, VV ECMO via a dual lumen cannula can provide sufficient gas exchange to allow for the removal of mechanical ventilatory support for patients awaiting lung transplantation.…”

Extracorporeal membrane oxygenation in the pre and post lung transplant period

“…Initial studies after the inception of LAS scoring noted that one-year outcomes in patients with higher LAS (17) and patients bridged with ECMO were lower (18,19). However, more recent studies analyzing the UNOS database have showed that outcomes in ECMO patient's post-lung transplant may be similar to non-ECMO patients, especially in centers with higher transplant volumes and experience (20,21).…”