Awake extracorporeal membrane oxygenation bridging for pulmonary retransplantation provides comparable results to elective retransplantation

Abstract

Lung retransplantation became an accepted treatment for bronchiolitis obliterans syndrome (BOS). However, the value of different bridging modalities for these patients is controversial. We analyzed outcomes of 39 patients listed for retransplantation between 2008 and 2012. Patients were divided in 3 groups: 23 patients without any bridge modality (elective, Group 1), 11 patients on ventilation and full sedation with or without extracorporeal membrane oxygenation (ECMO) support (sedated bridging, Group 2), and 5 patients awake on ECMO support (awake bridging, Group 3). Waiting list mortality was 13% in Group 1, 39% in Group 2, and 0% in Group 3. Perioperative mortality was 20% in Group 1, 29% in Group 2, and 0% in Group 3. Significant differences between Groups 1 and 2 were calculated for time on post-operative ventilation (17.4 vs 27.3 days, p = 0.022), intensive care unit stay (22.0 vs 32.9 days, p = 0.026), and hospital stay (34.7 vs 54.1 days, p = 0.013). However, there were no significant differences between Groups 1 and 3 for post-operative ventilation time (17.4 vs 13.4 days, p = 0.192), for intensive care unit stay (22.0 vs 26.4 days, p = 0.169), or for hospital stay (34.7 vs 34.8 days, p = 0.367). Survival rates at 90 days, 1 year, and 2 years were 80%, 70%, and 53% in Group 1; 71%, 43%, and 29% in Group 2; and 100%, 60%, and 60% in Group 3, respectively. Awake ECMO bridging for retransplantation provides comparable results to elective retransplantation.