The impact of pre-operative extracorporeal membrane oxygenation support on survival in lung transplantation surgery- ECMO as bridge to transplant

Objectives: Increasingly frequent, extracorporeal membrane oxygenation (ECMO) or extracorporeal lung assist (ECLA) is temporary used as a bridge to lung transplantation (LTX). This study was designed to compare survival after LTX in patients requiring ECMO with that of patients not pre-op supported by ECMO.

Methods: From 2002 to 2011 137 patients underwent LTX. 53% of patients presented with idiopathic pulmonary fibrosis and markedly elevated pulmonary artery pressure (70%).

Results: 14 patients required pre LTX ECMO or ECLA support (age 40.3±14 years, double-LTX 85.7%, female gender 57%) compared to 123 patients without pre LTX ECMO or ECLA use (age 53.1±12 years, double-LTX 51%, female gender 40.7%). Two patients from this 14 patients supported by ECMO or ECLA died before the LTX. One patient supported by ECLA was weaned from this support and successfully transplanted. Five additional patients were intra-operatively ECMO supported, and in six of these patients ECMO use was directly extended into the post-operative period. Nine patients required early (<7 days) post-operatively ECMO support primarily for severe graft dysfunction. Seven patients underwent delayed ECMO support for rejection. The short-term and mid-term survival was not significantly reduced in pre LTX ECMO/ECLA patients (LogRank p=0.28). The 30-day, 90-day and 1-year survival was 87.7%, 80.3% and 73.2% in the patients without ECMO, compared to 83.3%, 66.7% and 66.7% in the pre LTx ECMO/ECLA patients.

Conclusions: ECMO-supported patients represent the very sickest patient group of an already existing high-risk population with end-stage pulmonary disease. Although survival after LTX is not significantly reduced when pre LTX ECMO/ECLA use is necessary.