Outcome of ECMO as a Bridge to Lung Transplantation: Largest Experience from India

Abstract

Purpose Worldwide extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplant has been increasingly used in patients worsening on waiting list. There is paucity of literature about this subset of patients from India. Purpose of this study was to appraise the outcomes and survival in patients receiving ECMO as a bridge to lung transplantation (LTx) in our institute. Methods We retrospectively analysed our database for the patients receiving ECMO as a bridge to lung transplantation in our centre from April 2017 to March 2020. Patients who were not bridged and underwent lung transplant with intraoperative mechanical circulatory support formed the control group. Categorical outcomes were compared between study groups using Chi square test /Fisher's Exact test. The difference in the mean survival between different groups was compared by log rank test (mantel-cox). P value Results During the study period, 18 waitlisted patients (mean age 51.64 ± 13.87 years) were put on pretransplant ECMO with the intention of bridging of which 4 patients succumbed preceding the transplant. Patients with interstitial lung disease were more likely to receive ECMO bridging (n=14, 77%). 16 patients were put on Veno-Venous support and 2 needed Veno-Arterial support. The Mean duration of pre-operative ECMO support was 5.43 ± 5.06 days. Post-transplant, the median duration of mechanical ventilation was 9 days versus 3 days (p=0.002) and the median length of ICU stay was 23 days versus 12 days(p=0.02) in ECMO and control groups respectively. The difference in tracheostomy, renal replacement therapy, airway complications and mortality between the study groups was found to be insignificant (P >0.05). The mean survival time was 40.730 months in cases (95% CI 22.332 to 59.127) and 81.899 months in controls (95% CI 72.056 to 91.741). The difference in survival distribution between two groups was statistically not significant. (log rank test value χ2(2) = 2.448, P value= 0.118). Overall, there was 65% survival among the patients who underwent lung transplant with pretransplant ECLS, in the course of our research span. Conclusion Our data shows that ECMO as a bridge to LTx is an admissible option for these critical patients, thereby reducing waitlist mortality. Despite the risks, the candidacy for LTx is preserved.