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. 2023 Apr 28;5(2):91-99.
doi: 10.36628/ijhf.2023.0013. eCollection 2023 Apr.

Direct Extracorporeal Membrane Oxygenation Bridged Heart Transplantation: The Importance of Multi-Organ Failure

Ji Hoon Lim  1 , Soo Yong Lee  1 , Min Ho Ju  2 , Seok Hyun Kim  1 , Jin Hee Choi  1 , Min Ku Chon  1 , Sang Hyun Lee  1 , Ki Won Hwang  1 , Jeong Su Kim  1 , Yong Hyun Park  1 , Junehong Kim  1 , Kook Jin Chun  1 , Mi Hee Lim  2 , Chee-Hoon Lee  2 , Hyung Gon Je  2
Affiliations

Direct Extracorporeal Membrane Oxygenation Bridged Heart Transplantation: The Importance of Multi-Organ Failure

Ji Hoon Lim et al. Int J Heart Fail. .

Abstract

Background and objectives: Recently, approximately 40% of all heart transplantation (HTx) in South Korea are performed using the direct extracorporeal membrane oxygenation (ECMO) bridging method. We conducted a study to examine the clinical outcome of direct ECMO-bridged HTx and to investigate the impact of multi-organ failure (MOF).

Methods: From June 2014 to September 2022, a total of 96 adult patients who underwent isolated HTx at a single tertiary hospital were included in the study. The patients were sub-grouped into ECMO (n=48) and non-ECMO group (n=48), and the ECMO group was subdivided into awake (n=22) and non-awake (n=26) groups based on mechanical ventilator (MV) dependency. Baseline characteristics, 30-day, and 1-year mortality were analyzed retrospectively.

Results: The 1-year survival rate was significantly lower in the ECMO group (72.9% vs. 95.8%, p=0.002). There was a significant difference in the 30-day survival rate between the awake and non-awake ECMO groups (81.8% vs. 65.4%, p=0.032). In the univariate analysis of logistic regression for 1-year mortality, the odds ratio was 8.5 for ECMO bridged HTx compared to the non-ECMO group, 12.3 in patients who required MV (p=0.003), and 23 with additional hemodialysis (p<0.001).

Conclusions: Patients who required MV in ECMO bridged HTx showed higher preoperative MOF rates and early mortality than those extubated. When considering ECMO bridged HTx, the severity of MOF should be thoroughly investigated, and careful patient selection is necessary.

Keywords: Extracorporeal membrane oxygenation; Heart transplantation; Hepato-renal failure; Mechanical ventilation.

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Conflict of interest statement

Conflict of Interest: The authors have no financial conflicts of interest.

Figures

Figure 1
Figure 1. Flow chart of the study.
ECMO = extracorporeal membrane oxygenation; VA = veno-aterial.
Figure 2
Figure 2. Survival outcome after HTx. (A) Kaplan-Meier curve of all adult isolated HTx recipients divided by non-ECMO, awake ECMO and non-awake ECMO group. (B) Survival curve of non-ECMO and ECMO group. (C) Survival curve of awake-ECMO and non-awake ECMO group. (D) Survival rate of 30-day, 6-month, 12-month post HTx comparing each group. VA-ECMO, venoaterial extracorporeal membrane oxygenation.
ECMO = extracorporeal membrane oxygenation; SD = standard deviation; HTx = heart transplantation; VA = veno-aterial.
Figure 3
Figure 3. The ROC curves for predicting 1-year mortality in patient who received VA-ECMO support according to different variables.
ROC = receiver operating characteristic; VA = veno-aterial; ECMO = extracorporeal membrane oxygenation; IMPACT = index for mortality prediction after cardiac transplantation; MELD-XI = model for end-stage liver disease excluding international normalized ratio; hs-CRP = high-sensitivity C-reactive protein.
Figure 4
Figure 4. Annual adult isolated heart transplantation trends in our institution. There was strategy change in 2019 to manage the recipients who were waiting for transplant bridged with ECMO. Consequently, the rate of awake ECMO recipients increased from 18.8% to 59.4% among the entire VA-ECMO bridged HTx cases after 2019.
ECMO = extracorporeal membrane oxygenation; HTx = heart transplantation; VA = veno-aterial.
See this image and copyright information in PMC

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