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
. 2021 Nov 28;22(1):306.
doi: 10.1186/s12931-021-01905-7.

Long- and short-term clinical impact of awake extracorporeal membrane oxygenation as bridging therapy for lung transplantation

Nam Eun Kim  1   2 , Ala Woo  1 , Song Yee Kim  1 , Ah Young Leem  1 , Youngmok Park  1 , Se Hyun Kwak  1 , Seung Hyun Yong  1 , Kyungsoo Chung  1 , Moo Suk Park  1 , Young Sam Kim  1 , Ha Eun Kim  3 , Jin Gu Lee  3 , Hyo Chae Paik  3 , Su Hwan Lee  4
Affiliations

Long- and short-term clinical impact of awake extracorporeal membrane oxygenation as bridging therapy for lung transplantation

Nam Eun Kim et al. Respir Res. .

Abstract

Background: As lung transplantation (LTx) is becoming a standard treatment for end-stage lung disease, the use of bridging with extracorporeal membrane oxygenation (ECMO) is increasing. We examined the clinical impact of being awake during ECMO as bridging therapy in patients awaiting LTx.

Methods: In this single-center study, we retrospectively reviewed 241 consecutive LTx patients between October 2012 and March 2019; 64 patients received ECMO support while awaiting LTx. We divided into awake and non-awake groups and compared.

Results: Twenty-five patients (39.1%) were awake, and 39 (61.0%) were non-awake. The median age of awake patients was 59.0 (interquartile range, 52.5-63.0) years, and 80% of the group was men. The awake group had better post-operative outcomes than the non-awake group: statistically shorter post-operative intensive care unit length of stay [awake vs. non-awake, 6 (4-8.5) vs. 18 (11-36), p < 0.001], longer ventilator free days [awake vs. non-awake, 24 (17-26) vs. 0 (0-15), p < 0.001], and higher gait ability after LTx (awake vs. non-awake, 92% vs. 59%, p = 0.004), leading to higher 6-month and 1-year lung function (forced expiratory volume in 1 s: awake vs. non-awake, 6-month, 77.5% vs. 61%, p = 0.004, 1-year, 75% vs. 57%, p = 0.013). Furthermore, the awake group had significantly lower 6-month and 1-year mortality rates than the non-awake group (6-month 12% vs. 38.5%, p = 0.022, 1-year 24% vs. 53.8%, p = 0.018).

Conclusions: In patients with end-stage lung disease, considering the long-term and short-term impacts, the awake ECMO strategy could be useful compared with the non-awake ECMO strategy.

Keywords: Critical care; Extracorporeal membrane oxygenation; Lung transplantation; Respiratory function tests.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests that could have influenced the present study.

Figures

Fig. 1
Fig. 1
Study design
Fig. 2
Fig. 2
Kaplan–Meier survival curves of bridged ECMO patients according to the awake strategy. A Overall survival rate between the awake and non-awake groups in the total study population. B Overall survival rate between the awake and non-awake groups after propensity score matching of the APACHE II score and ECMO duration
Fig. 3
Fig. 3
Six-month and 1-year lung function after lung transplantation
See this image and copyright information in PMC

References

    1. Shah PD, Orens JB. Guidelines for the selection of lung-transplant candidates. Curr Opin Organ Transplant. 2012;17:467–473. doi: 10.1097/MOT.0b013e328357d898. - DOI - PubMed
    1. Mattar A, Chatterjee S, Loor G. Bridging to lung transplantation. Crit Care Clin. 2019;35:11–25. doi: 10.1016/j.ccc.2018.08.006. - DOI - PubMed
    1. Cooper JD, Pearson FG, Patterson GA, Todd TR, Ginsberg RJ, Goldberg M, DeMajo WA. Technique of successful lung transplantation in humans. J Thorac Cardiovasc Surg. 1987;93:173–181. doi: 10.1016/S0022-5223(19)36439-6. - DOI - PubMed
    1. Fuehner T, Kuehn C, Hadem J, Wiesner O, Gottlieb J, Tudorache I, Olsson KM, Greer M, Sommer W, Welte T, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med. 2012;185:763–768. doi: 10.1164/rccm.201109-1599OC. - DOI - PubMed
    1. Maurer JR, Frost AE, Estenne M, Higenbottam T, Glanville AR. International guidelines for the selection of lung transplant candidates. The International Society for Heart and Lung Transplantation, the American Thoracic Society, the American Society of Transplant Physicians, the European Respiratory Society. Transplantation. 1998;66:951–956. doi: 10.1097/00007890-199810150-00033. - DOI - PubMed