Usefulness of extracorporeal membrane oxygenation for early cardiac allograft dysfunction (original) (raw)
Related papers
The Journal of Heart and Lung Transplantation, 2011
BACKGROUND: This retrospective study investigated early outcome in patients with end-stage pulmonary disease bridged with extracorporeal membrane oxygenation (ECMO) with the intention of lung transplantation (LTx) in 2 Scandinavian transplant centers. METHODS: ECMO was used as a bridge to LTx in 16 patients between 2005 and 2009 at Sahlgrenska and Helsinki University Hospitals. Most patients were late referrals for LTx, and all failed to stabilize on mechanical ventilation. Thirteen patients (7 men) who were a mean age of 41 Ϯ 8 years (range, 25-51 years) underwent LTx after a mean ECMO support of 17 days (range, 1-59 days). Mean follow-up at 25 Ϯ 19 months was 100% complete. RESULTS: Three patients died on ECMO while waiting for a donor, and 1 patient died 82 days after LTx; thus, by intention-to-treat, the success for bridging is 81% and 1-year survival is 75%. All other patients survived, and 1-year survival for transplant recipients was 92% Ϯ 7%. Mean intensive care unit stay after LTx was 28 Ϯ 18 days (range, 3-53 days). All patients were doing well at follow-up; however, 2 patients underwent retransplantation due to bronchiolitis obliterans syndrome at 13 and 21 months after the initial ECMO bridge to LTx procedure. Lung function was evaluated at follow-up, and mean forced expiratory volume in 1 second was 2.0 Ϯ 0.7l (62% Ϯ 23% of predicted) and forced vital capacity was 3.1 Ϯ 0.6 l (74% Ϯ 21% of predicted). CONCLUSION: ECMO used as a bridge to LTx results in excellent short-term survival in selected patients with end-stage pulmonary disease.
Experience of extracorporeal membrane oxygenation as a bridge to lung transplantation in France
The Journal of Heart and Lung Transplantation, 2013
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is increasingly used as a bridge to lung transplantation (LTx). However, data concerning this approach remain limited. METHODS: We retrospectively reviewed the medical records of all patients in France who received ECMO as a bridge to LTx from 2007 to 2011. Post-transplant survival and associated factors were assessed by the Kaplan-Meier method and the Cox model. RESULTS: Included were 36 patients from 11 centers. Indications for LTx were cystic fibrosis (CF) in 20 (56%), pulmonary fibrosis (PF) in 11 (30%), and other diagnoses in 5 (14%). ECMO was venovenous for 27 patients (75%) and venoarterial for 9 (25%). Mean follow-up was 17 months. Bridging to LTx was achieved in 30 patients (83%); however, only 27 patients (75%) survived the LTx procedure, and 20 (56%) were discharged from hospital. From ECMO initiation, 2-year survival rates were 50.4% overall, 71.0% for CF patients, 27.3% for PF patients, and 20.0% for other patients (p o 0.001). From LTx, 2-year survival rates were 60.5% overall, 71.0% for CF patients, 42.9% for PF patients, and 33.0% for other patients (p ¼ 0.04). CONCLUSIONS: Our study confirms that the use of ECMO as a bridge to LTx in France could provide a medium-term survival benefit for LTx recipients with critical conditions. Survival differed by underlying respiratory disease. Larger studies are needed to further define the optimal use of ECMO. J Heart Lung Transplant 2013;32:905-913 r
The Annals of Thoracic Surgery, 2012
Background. Indications for extracorporeal membrane oxygenation (ECMO) use in lung transplantation are (1) temporary assistance as a bridge to transplantation, (2) stabilization of hemodynamics during transplantation in place of cardiopulmonary bypass, and (3) treatment of severe lung dysfunction and primary graft failure after transplantation. This study compares the survival of lung transplant recipients requiring ECMO support with survival of patients without ECMO.
ECMO in lung transplant: pre, intra and post-operative utilization—a narrative review
Current Challenges in Thoracic Surgery
The goal of this chapter is to evaluate the use of Extracorporeal Membrane Oxygenation (ECMO) in the lung transplant patient. ECMO will be evaluated pre, intra and post-operative lung transplant with discussion on cannulation, benefits and risks that can affect patient outcomes. Background: Patients with end-stage lung disease (ESLD) unresponsive to medical therapy will succumb to their disease unless they undergo lung transplantation which remains the gold standard for treatment. Unfortunately, there are not enough donors to meet the demand of the UNOS waitlist. Due to donor shortage and long wait times, some patients will not survive to transplant. The introduction of the current allocation system for lungs in 2005 was aimed to improve donor organ allocation and outcomes by determining disease burden and risk factors allowing for transplantation of the sickest patients first. ECMO is a form of temporary mechanical support that removes CO 2 and oxygenates the blood and can also provide hemodynamic support if needed. ECMO technology has rapidly expanded over the last 15 years and is now being used to support patients as a bridge-totransplant (BTT), intraoperative pulmonary and/or cardiac support and post-operative support in patients with severe graft dysfunction. Early results utilizing pre-operative ECMO support were not promising before 2010. Methods: Systematic review of the available literature to investigate ECMO in pre, intra and post-operative lung transplant patients. A systematic review of available research articles was reviewed from 1990 to 2021 to evaluate ECMO as a bridge to transplant. Focusing on the use of ECMO preoperatively, intraoperatively, and post operatively including the risk and benefits to the patient. Conclusions: Recent studies have shown survival outcomes in ECMO supported recipients comparable to non-ECMO recipients in appropriately selected patients, such as younger patients with single system failure. Intra-operatively, it is increasingly being used for hemodynamic support, especially in patients with fibrotic disease undergoing double lung transplantation via an anterior approach. Hybrid circuits allow for conversion from ECMO to full cardiopulmonary bypass (CPB) and back to ECMO easily. Current reports have also shown a decrease incidence of primary graft dysfunction in double lung transplants that are supported by intra-operative ECMO. With the improvements in ECMO technology and better patient management protocols, we can expect increasing use of this technology in lung transplantation.
Brazilian Journal of Cardiovascular Surgery
Introduction: Lung transplantation is the final treatment option for end-stage lung disease, and extracorporeal membrane oxygenation (ECMO) is increasingly being used during lung transplantation. Objective: The present study aimed to review our initial experience with patients who underwent lung transplantation with or without ECMO since the implementation of the lung transplantation program at our center. Methods: Data were prospectively collected on all patients between December 2016 and December 2018. Patients undergoing ECMO as a bridge to lung transplantation were excluded. Results: A total of 48 lung transplants were performed, and ECMO was used in 29 (60.4%) cases. Twenty (83%) patients were female. The median age was 48.5 (range, 14-64) years. The most common indications were idiopathic interstitial pneumonia in 9 (31%) patients, chronic obstructive pulmonary disease in 7 (24.1%) patients, and bronchiectasis in 6 (20.7%) patients. Sequential bilateral lung transplantation was performed in all patients. The 30-day mortality was 20.6% (6/29) for patients with ECMO, however, it was 10.5 (2/19) for patients without ECMO (P=0.433). The median length of stay in the intensive care unit (ICU) was 5 (range, 2-25) days. The ECMO weaning rate was 82.8% (24/29). One-year survival was 62.1% with ECMO versus 78.9% without ECMO, and the 3-year survival was 54.1% versus 65.8%, respectively (P=0.317). Conclusions: ECMO is indicated for more severe patients who underwent lung transplantation. The use of ECMO provides adjuvant support during surgery and the mortality rate is acceptable. Survival is also as similar as non-ECMO patients. ECMO is appropriate for critically ill patients.
Institutional experience with extracorporeal membrane oxygenation in lung transplantation☆
European Journal of Cardio-Thoracic Surgery, 2007
Background: Extracorporeal membrane oxygenation (ECMO) is currently accepted in lung transplantation either to bridge patients to transplantation or to treat postoperatively arising severe primary graft failure. Based on promising initial experiences we have since 2001 implemented ECMO as the standard of intraoperative extracorporeal support in lung transplantation (LuTX) patients with haemodynamic or respiratory instability with the potential to prolong ECMO support into the perioperative period. The aim of this paper is to summarise our total experience with the use of ECMO in LuTX. Methods: We retrospectively reviewed all 306 patients undergoing primary lung transplantation from 1/ 2001 to 1/2006 with regard to the different forms of ECMO use. Results of all patients requiring ECMO were compared to those without ECMO during the observation period. Results: ECMO was used in 147 patients in total. Two patients were bridged to transplantation. A total of 130 patients received intraoperative ECMO support. In 51 of these patients ECMO was prolonged into the perioperative period. Five of these patients required ECMO support again in the postoperative period due to graft dysfunction. Contrary cardiopulmonary bypass was used in 27 patients mainly with concomitant cardiac defects. Eleven of these patients needed therapeutic ECMO in the further course. A total of 149 patients without relevant risk factors were transplanted without any intraoperative extracorporeal support. Six of these patients required ECMO support in the postoperative period for treatment of primary graft dysfunction. Overall 3-month, 1-year and 3-year survival rates were 88.6%, 82.1% and 74.63%. The mentioned survival rates were 85.4%, 74.2% and 67.6% in the intraoperative AE prolonged ECMO group; 93.5%, 91.9% and 86.5% in the no support group and 74.0%, 65.9% and 57.7% in the CPB group. Conclusion: ECMO is a valuable tool in lung transplantation providing the potential to bridge patients to transplantation, to replace CPB with at least equal results and to overcome severe postoperative complications. Favourable survival rates can be achieved despite the fact that ECMO is used in the more complex patient population undergoing lung transplantation as well as to overcome already established severe complications. #
Extracorporeal membrane oxygenation after lung transplantation: risk factors and outcomes analysis
Annals of cardiothoracic surgery, 2019
Background: Lung transplantation is the treatment of choice for end-stage pulmonary disease in selected patients. However, severe primary graft dysfunction is a significant complication of transplant and requires the implantation of an extracorporeal support. The aim of the study is to evaluate the impact of extracorporeal membrane oxygenation (ECMO) after transplant in our center. Methods: From January 2008 till June 2018, 195 consecutive unselected patients receiving a lung transplant were considered. Mean age was 49±15 years. Main indications for transplant were idiopathic pulmonary fibrosis in 72 patients, chronic obstructive pulmonary disease in 60 patients, and cystic fibrosis in 40 patients. Prior to transplant, 18 patients were on mechanical ventilation and 14 were on ECMO. Results: Twenty-five patients required venous-venous ECMO after transplant. Vascular disease as cause of transplant [relative risk (RR) 7.8, 95% CI: 1.5-41, P=0.02], donor age (RR 1.6, 95% CI: 1.03-2.3, P=0.03) and need for cardiopulmonary bypass during transplant (RR 3.1, 95% CI: 1.02-9, P=0.04) were associated with ECMO implantation. Patients requiring post-transplant ECMO received more transfusions (P<0.01), had a longer mechanical ventilation (P<0.01) and ICU stay (P<0.01) and had a higher hospital mortality (P<0.01). Post-transplant ECMO significantly influenced one-and five-year survival [hazard ratio (HR) 5.5, 95% CI: 3-10, P<0.001 and HR 3.5, 95% CI: 2-6, P<0.001, respectively]. However, conditional survival after t months is similar for patients with or without post-transplant ECMO. Conclusions: In our experience, although ECMO is a reliable and effective strategy to support pulmonary function, severe graft dysfunction after lung transplantation still has a significant impact on early and late results.