Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jun;157(6):2515-2525.e10.
doi: 10.1016/j.jtcvs.2019.02.048. Epub 2019 Feb 27.

Twenty-year experience with extracorporeal life support as bridge to lung transplantation

Alberto Benazzo  1 , Stefan Schwarz  1 , Florian Frommlet  2 , Thomas Schweiger  1 , Peter Jaksch  1 , Peter Schellongowski  3 , Thomas Staudinger  3 , Walter Klepetko  1 , György Lang  4 , Konrad Hoetzenecker  5 ; Vienna ECLS Program
Collaborators, Affiliations
Free article

Twenty-year experience with extracorporeal life support as bridge to lung transplantation

Alberto Benazzo et al. J Thorac Cardiovasc Surg. 2019 Jun.
Free article

Abstract

Objectives: Extracorporeal life support is increasingly used to bridge deteriorating candidates to lung transplantation. Nevertheless, only few systematic reports with a limited number of patients exist describing this practice and its changes over time.

Methods: We retrospectively reviewed our institutional database and performed an era analysis to identify trends over time and risk factors for mortality. After applying propensity score matching, outcomes of bridged patients were compared with those of standard lung transplantation recipients.

Results: Extracorporeal life support was used in 120 patients as an intention to bridge to lung transplantation. Eleven patients (9.2%) were bridged between 1998 and 2004, 39 patients (32.5%) were bridged between 2005 and 2010, and 70 patients were bridged (58.3%) between 2010 and 2017. In the first era, the main bridging modality was venoarterial-extracorporeal membrane oxygenation (n = 10, 90.9%), whereas venovenous devices were primarily used in later eras (second era: n = 18, 46.2%; third era: n = 39, 55.8%). In the second and third eras, 9 patients (23.1%) and 24 patients (34.3%) could be bridged awake. Short-term outcome was poor in the first era, with only 36.4% of patients discharged alive but improved in later eras (53.8% and 77.1%; P = .002). Extracorporeal life support-bridged patients showed an impaired short-term outcome compared with standard recipients. However, survival conditional on 90 days did not differ among the groups (P = .178). In univariate and multivariate analyses, awake extracorporeal life support was protective for survival, whereas acute retransplantation was a risk factor for mortality.

Conclusions: Over the past 2 decades, the role of extracorporeal life support bridging evolved from an acute rescue therapy to a semi-elective procedure. Stratified outcome analysis revealed that extracorporeal life support bridging yielded similar long-term survival compared with nonbridged patients.

Keywords: ECLS; bridging; lung transplantation.

PubMed Disclaimer

Comment in