Impact of Extracorporeal Membrane Oxygenation Bridging Duration on Lung Transplant Outcomes

Benjamin L Shou; Andrew Kalra; Alice L Zhou; Iulia Barbur; Matthew T McGoldrick; Emily Larson; Steven P Keller; Bo Soo Kim; Glenn J R Whitman; Sung-Min Cho; Errol L Bush

doi:10.1016/j.athoracsur.2024.04.021

Impact of Extracorporeal Membrane Oxygenation Bridging Duration on Lung Transplant Outcomes

Ann Thorac Surg. 2024 May 11:S0003-4975(24)00361-8. doi: 10.1016/j.athoracsur.2024.04.021. Online ahead of print.

Authors

Affiliations

¹ Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD;. Electronic address: bshou1@jhmi.edu.
² Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
³ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
⁴ Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD;; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
⁵ Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD;; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD;; Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD.
⁶ Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.

PMID: 38740080
DOI: 10.1016/j.athoracsur.2024.04.021

Abstract

Background: We sought to characterize the association between venovenous extracorporeal membrane oxygenation (VV-ECMO) bridging duration and outcomes in patients listed for lung transplantation.

Methods: A retrospective observational study was conducted using the Organ Procurement and Transplantation Network (OPTN) database to identify adults (≥18 years old) who were listed for lung transplantation between 2016-2020 and who were bridged with VV-ECMO. Patients were then stratified into groups, determined by risk inflection points, depending on the amount of time spent on pre-transplant ECMO: Group 1 (≤5 days), Group 2 (6-10 days), Group 3 (11-20 days), and Group 4 (>20 days). Waitlist survival between groups was analyzed using Fine-Gray competing risk models. Post-transplant survival was compared using Cox regression.

Results: Of 566 eligible VV-ECMO bridge-to-lung-transplant patients (median age=54, 49% male), 174 (31%), 124 (22%), 130 (23%), and 138 (24%) were categorized as Groups 1, 2, 3, and 4, respectively. Overall, median duration of VV-ECMO was 10 days (range=1-211) and 178 patients (31%) died on the waitlist. In the Fine-Gray model, compared to Group 1, patients bridged with longer ECMO durations in Groups 2 (SHR=2.95, 95%CI: 1.63-5.35), 3 (SHR=3.96, 95%CI: 2.36-6.63), and 4 (SHR=4.33, 95%CI: 2.59-7.22, all p<0.001), were more likely to die on the waitlist. Of 388 patients receiving a transplant, pre-transplant ECMO duration was not associated with one-year survival in Cox regression.

Conclusions: Prolonged ECMO bridging duration was associated with worse waitlist mortality but did not impact post-lung transplant survival. Prioritization of very early transplantation may improve waitlist outcomes in this population.