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
. 2020 Nov 2;35(42):e346.
doi: 10.3346/jkms.2020.35.e346.

Clinical Outcomes of Early Extubation Strategy in Patients Undergoing Extracorporeal Membrane Oxygenation as a Bridge to Heart Transplantation

Taeho Youn  1 , Darae Kim  1 , Taek Kyu Park  1 , Yang Hyun Cho  2 , Su Hyun Cho  2 , Ji Yeon Choi  2 , Kiick Sung  2 , Jin Oh Choi  1 , Eun Seok Jeon  1 , Jeong Hoon Yang  1   3
Affiliations

Clinical Outcomes of Early Extubation Strategy in Patients Undergoing Extracorporeal Membrane Oxygenation as a Bridge to Heart Transplantation

Taeho Youn et al. J Korean Med Sci. .

Abstract

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) might be considered a bridge therapy in patients who are expected to have short waiting times for heart transplantation. We investigated the clinical outcomes of patients who underwent VA-ECMO as a bridge to heart transplantation and whether the deployment of an early extubation ECMO strategy is beneficial.

Methods: Between November 2006 and December 2018, we studied 102 patients who received VA-ECMO as a bridge to heart transplantation. We classified these patients into an early extubation ECMO group (n = 24) and a deferred extubation ECMO group (n = 78) based on the length of the intubated period on VA-ECMO (≤ 48 hours or > 48 hours). The primary outcome was in-hospital mortality.

Results: The median duration of early extubation VA-ECMO was 10.0 (4.3-17.3) days. The most common cause for patients to be put on ECMO was dilated cardiomyopathy (65.7%) followed by ischemic cardiomyopathy (11.8%). In-hospital mortality rates for the deferred extubation and early extubation groups, respectively, were 24.4% and 8.3% (P = 0.147). During the study period, in the deferred extubation group, 60 (76.9%) underwent transplantation, while 22 (91.7%) underwent transplantation in the early extubation group. Delirium occurred in 83.3% and 33.3% of patients from the deferred extubation and early extubation groups (P < 0.001) and microbiologically confirmed infection was identified in 64.1% and 41.7% of patients from the two groups (P = 0.051), respectively.

Conclusion: VA-ECMO as a bridge therapy seems to be feasible for deployment in patients with a short waiting time for heart transplantation. Deployment of the early extubation ECMO strategy was associated with reductions in delirium and infection in this population.

Keywords: Cardiogenic Shock; Early Extubation; Extracorporeal Membrane Oxygenation; Heart Transplantation.

PubMed Disclaimer

Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Study population. Flow chart of patients, who received VA-ECMO as a bridge to heart transplantation. The patients were classified into either early extubation group or deferred extubation group depending on the length of period intubated.
VA-ECMO = veno-arterial extracorporeal membrane oxygenation.
Fig. 2
Fig. 2. Duration of ECMO without mechanical ventilation in the early extubation group. A total of 24 patients were in the early extubation ECMO group. The length of period on early extubation ECMO for each patient ranged from 1 to 44 days with a median duration of 10.0 (4.3–17.3) days.
ECMO = extracorporeal membrane oxygenation.
Fig. 3
Fig. 3. Survival of patients bridged to HT with veno-arterial extracorporeal membrane oxygenation. Kaplan-Meier curve in heart transplantation recipients is shown, demonstrating a 1-year survival rate of 89.7% and a 5-year survival rate of 84.0% during the median follow up period of 637.5 (281.5–1548.8) days.
HT = heart transplantation.
See this image and copyright information in PMC

References

    1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Jr, Colvin MM, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136(6):e137–61. - PubMed
    1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–2200. - PubMed
    1. Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011;8(1):30–41. - PMC - PubMed
    1. Chaudhry SP, Stewart GC. Advanced heart failure: prevalence, natural history, and prognosis. Heart Fail Clin. 2016;12(3):323–333. - PubMed
    1. Lund LH, Edwards LB, Dipchand AI, Goldfarb S, Kucheryavaya AY, Levvey BJ, et al. The registry of the International Society for Heart and Lung Transplantation: thirty-third adult heart transplantation report-2016; focus theme: primary diagnostic indications for transplant. J Heart Lung Transplant. 2016;35(10):1158–1169. - PubMed