Outcome of Extracorporeal Membrane Oxygenation as a Bridge To Lung Transplantation

İnci, İlhan; Klinzing, Stephanie; Schneiter, Didier; Schuepbach, Reto A.; Kestenholz, Peter; Hillinger, Sven; Benden, Christian; Maggiorini, Marco; Weder, Walter

doi:10.1097/tp.0000000000000653

Cited by 77 publications

(15 citation statements)

References 26 publications

(97 reference statements)

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“…Our findings are in line with those of Mooney and colleagues, who reported an increasing number of patients requiring preoperative ICU admission, mechanical ventilation, or ECMO support [ 17 ]. In recent years, the utilization of ECMO for bridging to transplantation has become more widespread with an increasing number of centers reporting greater use, which is reflective of our findings as well, and underscores the trend for sicker patients being transplanted [ 18 – 20 ]. Furthermore, Keller et al reported that patients with the highest LAS have substantially greater healthcare utilization, noting an increasing trend in the percent of patients requiring preoperative hospitalization – up to 15% of all recipients in the 2012 through 2015 study period [ 21 ].…”

Section: Discussionsupporting

confidence: 55%

What Awaits on the Other Side: Post-Lung Transplant Morbidity and Mortality After Pre-Transplant Hospitalization

et al. 2020

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Background Morbidity and mortality rates after lung transplantation remain high compared to other solid organ transplants. In the lung allocation score era, patients given the highest priority on the waitlist are those with the greatest severity of illness, who often require preoperative hospitalization. Material/Methods To determine the association of pre-transplant hospitalization with post-transplant outcomes, we retrospectively evaluated 448 lung transplant recipients at our center between January 2010 and July 2017 (114 hospitalized; 334 outpatient). Results Survival was similar between the groups (hazard ratio 0.93 [95% CI 0.61 to 1.42], p=0.738). However, hospitalized patients had longer hospital and intensive care unit length of stay compared to outpatients – 25 vs. 18 days, (p<0.001) and 9.5 vs. 6 days, (p<0.001), respectively. Hospitalized patients had higher rates of Grade 3 primary graft dysfunction – 29.8% vs. 9.6%, p<0.001 – and remained mechanically ventilated longer – 6 vs. 3 days, p<0.001. A greater percentage of hospitalized patients needed a tracheostomy and a re-operation within 30 days – 39.5% vs. 15.3% (p<0.001) and 22.8% vs. 12.0% (p=0.005) – respectively. After discharge, 28% of hospitalized patients required acute rehabilitation compared with 12% of outpatients (p=0.001). Conclusions While pre-transplant hospitalization is not associated with mortality, it is associated with significant morbidity after transplant.

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Section: Discussionsupporting

confidence: 55%

What Awaits on the Other Side: Post-Lung Transplant Morbidity and Mortality After Pre-Transplant Hospitalization

et al. 2020

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“…While the ROSC rate was similar in both groups, patients treated with cardiopulmonary bypass were weaned faster due to more hemolysis and systemic inflammation. In contrast, using femorofemoral ECLS, circulatory support lasting several days is possible, allowing time for the myocardium and respiratory function to recover before weaning [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary responses during the cooling and the extracorporeal life support rewarming phases in a porcine model of accidental deep hypothermic cardiac arrest

Debaty

Maignan

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundThis study aimed to assess cardiac and pulmonary pathophysiological responses during cooling and extracorporeal life support (ECLS) rewarming in a porcine model of deep hypothermic cardiac arrest (DHCA). In addition, we evaluated whether providing a lower flow rate of ECLS during the rewarming phase might attenuate cardiopulmonary injuries.MethodsTwenty pigs were cannulated for ECLS, cooled until DHCA occurred and subjected to 30 min of cardiac arrest. In order to assess the physiological impact of ECLS on cardiac output we measured flow in the pulmonary artery using Doppler echocardiography as well as a modified thermodilution technique using the Swan-Ganz catheter (injection site in the right ventricle). The animals were randomized into two groups during rewarming: a group with a low blood flow rate of 1.5 L/min (LF group) and a group with a normal flow rate of 3.0 L/min (NF group). The ECLS temperature was adjusted to 5 °C above the central core. Cardiac output, hemodynamics and pulmonary function parameters were evaluated.ResultsDuring the cooling phase, cardiac output, heart rhythm and blood pressure decreased continuously. Pulmonary artery pressure tended to increase at 32 °C compared to the initial value (20.2 ± 1.7 mmHg vs. 29.1 ± 5.6 mmHg, p = 0.09). During rewarming, arterial blood pressure was higher in the NF than in the LF group at 20° and 25 °C (p = 0.003 and 0.05, respectively). After rewarming to 35 °C, cardiac output was 3.9 ± 0.5 L/min in the NF group vs. 2.7 ± 0.5 L/min in LF group (p = 0.06). At the end of rewarming under ECLS cardiac output was inversely proportional to the ECLS flow rate. Moreover, the ECLS flow rate did not significantly change pulmonary vascular resistance.DiscussionUsing a newly developed experimental model of DHCA treated by ECLS, we assessed the cardiac and pulmonary pathophysiological response during the cooling phase and the ECLS rewarming phase. Despite lower metabolic need during hypothermia, a low ECLS blood flow rate during rewarming did not improved cardiopulmonary injuries after rewarming.ConclusionA low ECLS flow rate during the rewarming phase did not attenuate pulmonary lesions, increased blood lactate level and tended to decrease cardiac output after rewarming. A normal ECLS flow rate did not increase pulmonary vascular resistance compared to a low flow rate. This experimental model on pigs contributes a number of pathophysiological findings relevant to the rewarming strategy for patients who have undergone accidental DHCA.

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“…Patients can have complex chemotherapy 11 or immunotherapy regimens that cause a severe systemic inflammatory response and are supported with ECMO. ECMO is increasingly being used as a long-term bridge to facilitate lung transplantation 12 , 13 . The use of ECMO in adult cardiorespiratory failure to resuscitate from cardiogenic shock and transport to local cardiac surgical centres for long-term support with ventricular assist devices and transplant programs is also increasingly available 14 , 15 .…”

Section: The Use Of Extracorporeal Membrane Oxygenation To Facilitatementioning

confidence: 99%

Extracorporeal membrane oxygenation 2016: an update

Butt

MacLaren

2016

F1000Res

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The use of extracorporeal membrane oxygenation (ECMO) is an important issue for intensivists, critical care nurses, surgeons, cardiologists, and many others. There has been a continued increase in the number of centres performing ECMO. This review examines novel applications and recent trends in the use of ECMO over the last 2 years. These include ECMO to facilitate the safe use of other treatments, changing the timing of initiation, newer equipment and better biocompatibility, and the ability of ECMO programs to essentially choose which cluster of potential complications they are prepared to accept. ECMO continues to evolve, diversify in its applications, and improve in safety.

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Outcome of Extracorporeal Membrane Oxygenation as a Bridge To Lung Transplantation

Abstract: Our data show significantly lower survival in this high-risk group compared to patients transplanted without preoperative ECLS. Awake and ambulatory ECLS provides the best prognosis for these high-risk patients.

Cited by 77 publications

References 26 publications

What Awaits on the Other Side: Post-Lung Transplant Morbidity and Mortality After Pre-Transplant Hospitalization

What Awaits on the Other Side: Post-Lung Transplant Morbidity and Mortality After Pre-Transplant Hospitalization

Cardiopulmonary responses during the cooling and the extracorporeal life support rewarming phases in a porcine model of accidental deep hypothermic cardiac arrest

Extracorporeal membrane oxygenation 2016: an update

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