Long- and short-term clinical impact of awake extracorporeal membrane oxygenation as bridging therapy for lung transplantation

Seung Hyun Yong,Moo Suk Park,Su Hwan Lee,Ah Young Leem,Kyungsoo Chung,Ha Eun Kim,Ala Woo,Youngmok Park,Se Hyun Kwak,Nam Eun Kim,Song Yee Kim,Young Sam Kim,Hyo Chae Paik,Jin Gu Lee

doi:10.1186/s12931-021-01905-7

Abstract

BackgroundAs lung transplantation (LTx) is becoming a standard treatment for end-stage lung disease, the use of bridging with extracorporeal membrane oxygenation (ECMO) is increasing. We examined the clinical impact of being awake during ECMO as bridging therapy in patients awaiting LTx.MethodsIn this single-center study, we retrospectively reviewed 241 consecutive LTx patients between October 2012 and March 2019; 64 patients received ECMO support while awaiting LTx. We divided into awake and non-awake groups and compared.ResultsTwenty-five patients (39.1%) were awake, and 39 (61.0%) were non-awake. The median age of awake patients was 59.0 (interquartile range, 52.5–63.0) years, and 80% of the group was men. The awake group had better post-operative outcomes than the non-awake group: statistically shorter post-operative intensive care unit length of stay [awake vs. non-awake, 6 (4–8.5) vs. 18 (11–36), p < 0.001], longer ventilator free days [awake vs. non-awake, 24 (17–26) vs. 0 (0–15), p < 0.001], and higher gait ability after LTx (awake vs. non-awake, 92% vs. 59%, p = 0.004), leading to higher 6-month and 1-year lung function (forced expiratory volume in 1 s: awake vs. non-awake, 6-month, 77.5% vs. 61%, p = 0.004, 1-year, 75% vs. 57%, p = 0.013). Furthermore, the awake group had significantly lower 6-month and 1-year mortality rates than the non-awake group (6-month 12% vs. 38.5%, p = 0.022, 1-year 24% vs. 53.8%, p = 0.018).ConclusionsIn patients with end-stage lung disease, considering the long-term and short-term impacts, the awake ECMO strategy could be useful compared with the non-awake ECMO strategy.

Highlights

As lung transplantation (LTx) is becoming a standard treatment for end-stage lung disease, the use of bridging with extracorporeal membrane oxygenation (ECMO) is increasing
Our hospital initiated awake ECMO in 2015, and in this study, we evaluated the clinical impact of awake ECMO as s bridging therapy in patients awaiting Lung transplantation (LTx)
Baseline characteristics of the patients receiving bridged ECMO according to the awake strategy A total of 64 patients were treated with bridged ECMO; their median age was 56.5 (IQR, 49.3–62.8) years, and 41 (64.1%) patients were men

Summary

Introduction

As lung transplantation (LTx) is becoming a standard treatment for end-stage lung disease, the use of bridging with extracorporeal membrane oxygenation (ECMO) is increasing. Kim et al Respiratory Research (2021) 22:306 strategies due to acute or chronic respiratory failure [1,2,3] These issues have increased the interest in bridging strategies for LTx candidates who become too sick to survive until an organ is available. Bridging with extracorporeal membrane oxygenation (ECMO) can reduce the risk of refractory hypercapnia or hypoxia requiring a mechanical ventilator [4]. It was contraindicated with LTx in the 1970s and 1980s because of poor perioperative outcomes and many complications [5, 6]. As the techniques and experiences related to ECMO improved, the literature on pre-transplant ECMO showed postoperative benefits in high-risk candidates; the proportion of patients receiving bridging ECMO is increasing [7,8,9,10,11]

Methods

Results

Discussion

Conclusion