Chest
Original ResearchTransplantationOrgan Allocation Waiting Time During Extracorporeal Bridge to Lung Transplant Affects Outcomes
Section snippets
Materials and Methods
All patients treated with ECMO bridging to LTX from May 2007 to May 2011 in two Italian centers (Ospedale Cà Granda of Milan and Policlinico San Matteo of Pavia) were included in this retrospective analysis. All patients were already listed for LTX and received ECMO support when their end-stage respiratory failure deteriorated to terminal hypoxemia and/or hypercapnia. Some had concomitant right-sided heart failure.
We recorded anthropometric data, the type of lung disease that led to LTX
Results
Twenty-five patients received an extracorporeal bridge to LTX. Population characteristics are described in Table 1. Seventeen of 25 patients (68%) underwent a transplant (Fig 1). None of the patients who did not undergo a transplant survived. None of the deaths while awaiting LTX was due to bleeding or technical problems with ECMO (three patients died of multiple organ failure, two of septic shock, two of cardiogenic shock, and one of intestinal ischemia). Three of the 17 patients who underwent
Discussion
Our report confirms that ECMO bridging is feasible and that the survival rate is good enough to justify its use. However, the main finding of our report is that the duration of ECMO support while awaiting organ allocation strongly affects morbidity and mortality. We also found that patients who maintain spontaneous breathing on NIV during ECMO bridging have a lower morbidity before and after LTX.
We found that the time on ECMO was a significant risk factor for death, either during the bridge or
Conclusions
This report confirms that ECMO bridging is feasible and provides encouraging survival results. It shows, we believe for the first time, that the duration of the ECMO bridge is a critical cofactor for mortality and morbidity both before and after LTX. Furthermore, combining ECMO with NIV may decrease the morbidity of patients bridged to LTX.
Acknowledgments
Author contributions: Dr Crotti had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Crotti: contributed to the clinical management, development of the study, data analysis and interpretation, data review, and writing of the manuscript.
Dr Iotti: contributed to the clinical management, development of ideas and study interpretation, writing and review of manuscript drafts, and approval of the final version
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Funding/Support: This study was partially funded by the Regione Lombardia “Project for Independent Research in the Intensive Care Field” [13465/2010].
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