Survival Analysis Evaluating Extracorporeal Membrane Oxygenation and Mechanical Ventilation as a Bridge to Lung Transplantation

Abstract

Purpose Extracorporeal membrane oxygenation (ECMO) is underutilized as bridge to lung transplantation (LTx) when compared to conventional mechanical ventilation (MV) in patients with end-stage lung failure. We sought to evaluate short-term outcomes in lung transplant recipients requiring preoperative advanced life support. Methods We retrospectively reviewed UNOS database to identify primary adult LTx recipients (1/2008 to 6/2017) who had no support (NO), MV, ECMO or both MV and ECMO (MVE) prior to LTx. Baseline characteristics were compared via chi-square and ANOVA. One-year survival was compared among the four groups using the Kaplan-Meier method and multivariate Cox proportional hazards regression for one-year survival was conducted to adjust for potential confounders. Results Of 16,392 recipients, there were 204 (1.2%) ECMO, 719 (4.4%) MV, and 350 (2.1%) MVE prior to transplant, with survival depicted in Fig 1. The NO cohort was older (57y) compared to MV (52y), ECMO (48y), and MVE (45y), p Conclusion Short-term survival utilizing ECMO as a bridge to LTx is favorable. Further evaluation into patient selection and direct comparison to conventional MV is warranted.