Utilization and Outcomes of Non-Intubated Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplant.

Background: Non-intubated extracorporeal membrane oxygenation (ECMO) has become an increasingly common method of support for patients with severe respiratory failure. Since data on its use as a bridge to lung transplant remain limited to single-center studies, we evaluated its use in a national cohort.

Methods: Adult lung-only transplant recipients bridged with ECMO 5/4/2005-3/8/2023 in the United Network for Organ Sharing database were categorized by use of ECMO and mechanical ventilation at transplant (ECMO+MV vs. ECMO-only). We compared post-transplant intubation and ECMO at 72 hours using logistic regression, length of stay using negative binomial regression, and post-transplant survival using Cox regression.

Results: The 1,599 transplants identified included 902 (56.4%) bridged with ECMO+MV and 697 (43.6%) bridged with ECMO-only. ECMO-only recipients had higher median age (52 vs. 49 years, p<0.001), shorter ischemic times (5.7 vs. 6.0 hours, p=0.003), and similar lung allocation scores (89.5 vs. 89.6, p=0.11). ECMO-only recipients had lower likelihood of intubation at 72 hours (56.5% vs. 77.5%; aOR 0.33 [95% CI: 0.25, 0.42], p<0.001) and shorter lengths of stay (28 vs. 35 days; coefficient -0.19 [95% CI: -0.27, -0.11], p<0.001). ECMO-only recipients had higher 90-day survival (92.1% vs. 89.1%; aHR 0.69 [95% CI: 0.48, 0.99], p=0.04) but similar 1-year (83.1% vs. 81.5%; aHR 0.87 [95% CI: 0.67, 1.12], p=0.27) and 5-year (54.6% vs. 54.7%; aHR 0.98 [95% CI: 0.82, 1.17], p=0.83) survival.

Conclusions: Non-intubated ECMO bridge to lung transplant was associated with improved perioperative outcomes and short-term survival and should be considered for candidates requiring ECMO.