Extracorporeal membrane oxygenation (ECMO), when used as bridge to lung transplantation (BTT) identifies high-risk candidates. Recent advances in cannula design and patient selection fosters “awake ambulatory ECMO” as a viable option for critically ill candidates in an attempt to retard deconditioning while awaiting allografts.
From 2012 to 2015, 30 patients underwent ECMO as BTT. Candidacy for ECMO was determined prior to listing for transplant. A dual lumen single cannula (DLSC) was utilized first in 13/30(43%) patients. The remaining patients were supported on veno-arterial ECMO in 6/30(20%) or veno-venous ECMO with double site cannulation in 11/30(37%) with 6/11 converted to DLSC. All ECMO patients with managed in a dedicated heart/lung failure intensive care unit (ICU) and early aggressive physical therapy, ambulation, and spontaneous breathing trials were emphasized.
Twenty-six (87%) patients were successfully bridged to transplantation. In patients with DLSC 5/19(26%) were successfully ambulated and 6/19(32%) achieved spontaneous ventilation. Median, 25th and 75th percentile ICU length of stay (LOS) and hospital LOS were 33 (20,46) and 56(28,78) days respectively; in patients successfully ambulated, these were 20 and 31 days respectively (P=0.5 (ICU), 0.4 (Hospital)). Among all transplanted patients, 30 day, 1-year, and 3-year survival were 92%, 85%, and 80% respectively. Among patients undergoing primary transplants, 3-year survival was 91%.
ECMO as BTT has led to encouraging perioperative outcomes and early survival. Careful patient selection and early utilization of ECMO seems to allow for preservation of vitality while these critically ill candidates await donor organs, which may improve outcomes.