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

IF 1.2 4区 医学 Q3 ANESTHESIOLOGY
Samantha L Ennis, Bronwyn J Levvey, Helen V Shingles, Jitain K Sivarajah, Philip Marsh, David Pilcher, Vincent Pellegrino, Gregory I Snell
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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.

为成功实现体外膜氧合作为肺移植的桥梁铺平了道路。
暴发性呼吸衰竭患者可以接受体外膜氧合(ECMO)作为肺移植(LTx)的桥梁。从历史上看,这种方法的发病率和死亡率一直很高。本研究的目的是描述当前的适应症,并确定预测成功结果的患者特征。我们进行了回顾性审计,包括11年期间(2010年1月1日至2020年12月31日)在Alfred Health转诊并通过ECMO进行LTx桥接的所有患者。收集患者、临床和供体特征,并将结果与同一时期的所有肺移植受者进行比较。接受了28例LTx转诊,25例ECMO患者最终被添加到LTx的等待名单中。与非ECMO组(平均年龄52.4岁)相比,接受ECMO桥接的患者相对年轻(平均年龄30岁)。在等候名单上的25人中,有3人在等待LTx时死亡。ECMO组从等待名单激活到LTx的中位时间为7天(四分位间距(IQR) 2-16),而非ECMO组为92天(IQR 38-218)天(P P = 0.73)。ECMO可以成功地在终末期肺病患者与LTx之间架起桥梁。通过遵守严格的方案和患者选择,ECMO可以提供与不需要ltx前支持的患者相当的中期生存结果。
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来源期刊
CiteScore
2.70
自引率
13.30%
发文量
150
审稿时长
3 months
期刊介绍: Anaesthesia and Intensive Care is an international journal publishing timely, peer reviewed articles that have educational value and scientific merit for clinicians and researchers associated with anaesthesia, intensive care medicine, and pain medicine.
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