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. 2024 Jan;43(1):77-84.
doi: 10.1016/j.healun.2023.06.016. Epub 2023 Jun 30.

Extracorporeal membrane oxygenation as a bridge to lung transplantation: Practice patterns and patient outcomes

Hannah J Rando  1 , Jonathon P Fanning  2 , Sung-Min Cho  3 , Bo S Kim  4 , Glenn Whitman  2 , Errol L Bush  5 , Steven P Keller  6
Affiliations

Extracorporeal membrane oxygenation as a bridge to lung transplantation: Practice patterns and patient outcomes

Hannah J Rando et al. J Heart Lung Transplant. 2024 Jan.

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is increasingly relied on to bridge patients with respiratory failure to lung transplantation despite limited evidence for its use in this setting. This study evaluated longitudinal trends in practice patterns, patient characteristics, and outcomes in patients bridged with ECMO to lung transplant.

Methods: A retrospective review of all adult isolated lung transplant patients in the United Network for Organ Sharing database between 2000 and 2019 was performed. Patients were classified as "ECMO" if supported with ECMO at the time of listing or transplantation and "non-ECMO" otherwise. Linear regression was used to evaluate trends in patient demographics during the study period. Trends in mortality were evaluated using Cox proportional hazards modeling, with time period as the primary covariate (2000-2004, 2005-2009, 2010-2014, or 2015-2019) and age, time on the waitlist, and underlying diagnosis as covariates.

Results: The number of patients included were 40,866, of whom 1,387 (3.4%) were classified as ECMO and 39,479 (96.6%) as no ECMO. Average age and initial Lung Allocation Score increased significantly during the study period in both cohorts, but occurred at a slower rate in the ECMO population. The hazard of death was significantly lower in more recent years (2015-2019) for both the ECMO and non-ECMO cohorts (aHR (adjusted hazards ratio) 0.59, 95% confidence interval (CI) 0.37-0.96 and aHR 0.74, 95% CI 0.70-0.79) when compared to the early years (2000-2004) of the study period.

Conclusions: Post-transplantation survival for patients bridged to transplantation with ECMO demonstrates ongoing improvement despite cannulation of progressively older and sicker patients.

Keywords: ECMO; bridge to transplant; lung transplant; trends.

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Conflict of interest statement

DECLARATION OF COMPETING INTEREST:

There are no relevant financial disclosures.

Figures

Figure 1:
Figure 1:. Trends of ECMO use over time
Histogram of patients supported on ECMO at the time of listing and time of transplantation between 2000 and 2019 in relation to the total number of lung transplants. ECMO=extracorporeal membrane oxygenation.
Figure 2:
Figure 2:. Trends in patient age at the time of listing for lung transplantation from 2000–2019
Predicted age at time of listing for ECMO patients compared to non-ECMO patients. ECMO patients include patients on ECMO at the time of registration for transplant as well as patients on ECMO at the time of transplantation. Non-ECMO patients were not supported with ECMO at any point in time. ECMO=extracorporeal membrane oxygenation.
Figure 3:
Figure 3:. Trends in Lung Allocation Score from 2000–2019
Predicted LAS at listing (Figure 3a) and waitlist removal (Figure 3b) for ECMO patients compared to non-ECMO patients over time. ECMO patients include patients on ECMO at the time of registration for transplant as well as patients on ECMO at the time of transplantation. Non-ECMO patients were not supported with ECMO at any point in time. LAS= lung allocation score. ECMO=extracorporeal membrane oxygenation.
Figure 4:
Figure 4:. Trends in time on the waitlist for lung transplant patients from 2000–2019
Predicted waitlist time for ECMO patients compared to non-ECMO patients. ECMO patients include patients on ECMO at the time of registration for transplant as well as patients on ECMO at the time of transplantation. No ECMO patients were not supported with ECMO at any point in time.
See this image and copyright information in PMC

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