Early Outcomes with the Use of ExtraCorporeal Membrane Oxygenation as a Bridge to Combined Heart and Lung Transplant

Abstract

Purpose There is limited evidence to support the use of ExtraCorporeal Membrane Oxygenation (ECMO) as a bridge to combined heart-lung transplantation (HLT). This may become an important tool to get patients transplanted considering the new heart status allocation system. We sought to evaluate the outcomes with the use of ECMO as a bridge to HLT in the United States. Methods We retrospectively reviewed 1039 adult HLT in the UNOS database between 1987 and 2018. We divided the patients’ population in three groups based on the use of mechanical support before HLT: ECMO bridge (38/1039), mechanical ventilation (MV) only (41/1039) and no support (960/1039). Survival curves were estimated by Kaplan-Meier method and compared by Cox proportional hazards model. Predictors of in-hospital mortality were analysed by logistic regression. Results Demographics by group are depicted in Figure 1. Thirty days and 1-year mortality for the ECMO, MV and no support group were 50%, 34%, 16% and 50%, 55.5%, 31%, respectively (p<0.0001; p<0.0001) (figure 2). The use of ECMO and MV as a bridge to transplant were identified as strong predictors for in-hospital mortality (OR=4.5; CI 95%= 2.2-9.2; p<0.0001 and OR=3.85; CI 95%= 1.55-9.49; p=0.003, respectively). There was no significant difference in post-transplant acute rejection and airway dehiscence between the three groups (p=0.5 and p=0.6, respectively). Conclusion The use of ECMO as a bridge strategy to combined HLT is associated with high early mortality. These results should be weighted at the time of candidacy to transplant and may negatively affect organ allocation in combined HLT. There is limited evidence to support the use of ExtraCorporeal Membrane Oxygenation (ECMO) as a bridge to combined heart-lung transplantation (HLT). This may become an important tool to get patients transplanted considering the new heart status allocation system. We sought to evaluate the outcomes with the use of ECMO as a bridge to HLT in the United States. We retrospectively reviewed 1039 adult HLT in the UNOS database between 1987 and 2018. We divided the patients’ population in three groups based on the use of mechanical support before HLT: ECMO bridge (38/1039), mechanical ventilation (MV) only (41/1039) and no support (960/1039). Survival curves were estimated by Kaplan-Meier method and compared by Cox proportional hazards model. Predictors of in-hospital mortality were analysed by logistic regression. Demographics by group are depicted in Figure 1. Thirty days and 1-year mortality for the ECMO, MV and no support group were 50%, 34%, 16% and 50%, 55.5%, 31%, respectively (p<0.0001; p<0.0001) (figure 2). The use of ECMO and MV as a bridge to transplant were identified as strong predictors for in-hospital mortality (OR=4.5; CI 95%= 2.2-9.2; p<0.0001 and OR=3.85; CI 95%= 1.55-9.49; p=0.003, respectively). There was no significant difference in post-transplant acute rejection and airway dehiscence between the three groups (p=0.5 and p=0.6, respectively). The use of ECMO as a bridge strategy to combined HLT is associated with high early mortality. These results should be weighted at the time of candidacy to transplant and may negatively affect organ allocation in combined HLT.