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Lessons Learned From Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation
*Vladimir Shumaster, *Oliver Jawitz, *Davd D Yuh, *Pramod N Bonde
Yale University School of Medicine, New Haven, CT


Objective:
To determine if using ECMO as a bridge to lung transplantation provides a survival benefit.
Design: Retrospective analysis of the United Network of Organ Sharing (UNOS) database, from January 2000 to December 2011, was performed to compare outcomes of lung and heart-lung transplant recipients bridged to transplant with ECMO versus those that were not (control group).
Setting: The largest multicenter cohort of ECMO-bridged lung transplant recipients to date.
Patients: During these eleven years there were 14263 lung transplants performed, of which 143 patients (1.0%) were bridged using ECMO.
Interventions: ECMO as a bridge to lung transplantation
Main outcomes measures: The primary end points was patient survival.
Results: The thirty-day, 6-month, 1 year, 3 year, and 5 year survival rates were 69%, 56%, 48%, 26%, and 11%, respectively for the ECMO bridge group and 95%, 88%, 81%, 58%, and 38% respectively for the control group (p= <0.01). The ECMO group incurred a higher rate of postoperative complications, including airway dehiscence (4% vs. 1%, p=<0.01), stroke (3% vs. 2%, p=<0.01), infection requiring antibiotic therapy (56% vs. 42%, p=<0.01), post-transplant dialysis (32% vs. 6%, p=<0.01), and pulmonary embolism (10% vs. 0.6%, p=<0.01), as well as higher blood transfusion requirements (34% vs. 4%, p=<0.01). The length of hospital stay was also longer for the ECMO group (41 days vs. 25 days, p=<0.01) and they were treated for rejection more often (49% vs. 36%, p=0.02).
Conclusion: The use of ECMO support as a bridge to lung transplantation is associated with significantly worse survival and more frequent postoperative complications. Therefore we advocate very careful patient selection and cautious use of ECMO in this capacity.


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