Paving a pathway for successful implementation of extracorporeal membrane oxygenation as a bridge to lung transplantation

Abstract

Patients with fulminant respiratory failure may receive extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (LTx). Historically, morbidity and mortality with this approach has been high. The aim of this study is to describe the current indications and identify patient characteristics that predict a successful outcome. We performed a retrospective audit including all patients referred and bridged to LTx with ECMO at Alfred Health over an 11-year period (between 1 January 2010 and 31 December 2020). Patient, clinical and donor characteristics were collected, and outcomes were compared with all lung transplant recipients over the same time period. Twenty-eight referrals for LTx were received and 25 patients on ECMO were ultimately added to the waiting list for LTx. Patients bridged with ECMO were comparatively young (mean age 30 years) compared with the non-ECMO group (mean age 52.4 years). Of the 25 on the waiting list, three died awaiting LTx. Median time from waiting list activation to LTx was seven (interquartile range (IQR) 2–16) days in the ECMO group, compared with 92 (IQR 38–218) days in the non-ECMO group (P < 0.001). Survival for the 22 patients bridged to LTx with ECMO was 95% at 30 days, 86% at one year and 64% at three years. There was no significant difference in median survival between the ECMO group versus the contemporaneous non-ECMO lung transplant recipients (P = 0.73). ECMO can be used successfully to bridge patients with end-stage lung disease to LTx. With adherence to stringent protocols and patient selection, ECMO can provide medium-term survival outcomes comparable to patients who did not require pre-LTx support.