Background

Extracorporeal membrane oxygenation (ECMO) is increasingly utilized as bridge to lung transplantation (LT), with studies reporting one-year survival of 50-90%. Lower than expected survival has brought into question the viability of ECMO as a bridging technique. During the last two years, we implemented clinical protocols aimed at maintaining physical conditioning including use of Avalon® cannula, early extubation where feasible, minimizing blood products, and strict adherence to limiting duration of non-ambulatory ECMO to maximum of two weeks. Herein we report our outcomes using ECMO as bridge to transplant (BTT) and describe predictors of successful BTT.

Methods

Any patient with advanced lung disease needing ECMO support as BTT between Jan 2014 to July 2015 were included (n=21,mean age: 51.4±14.2 years,range 14-66 years). We reviewed clinical and laboratory variables before and after initiation of ECMO, development of organ dysfunction and hospital and 1 year survival. Variables were compared between patients with successful BTT vs non-survivors using Mann-Whitney U test and Chi-square test as appropriate.

Results

Most patients were waitlisted at ECMO initiation (13/21), rest (n=8) underwent transplant evaluation on ECMO. Eleven patients (52.4%) were successfully bridged to LT. Patients worked up for LT while on ECMO had better survival (87.5%vs30.8%;OR,95%CI: 15.7,1.4-174.2;p=0.011). Post-ECMO initiation, three variables were significant predictors of successful BTT: trough serum albumin (SA)>2.5 g/dL (successful BTT:91.7%vs0, p<0.001), peak blood urea (BUN)<35 mg/dL(75%vs22.2%;OR,95%CI: 3.8,1.03-14.4; p=0.02) and peak aspartate transaminase (AST)<85 IU/L(66.7%vs20%;OR,95%CI: 5.5,0.8-39.4; p=0.04). Proportion of patients successfully BTT was strongly associated with the number of lab abnormalities (no lab abnormalities: 100% survival; 1:75%, 2 or more:0%; p<0.001). One-year survival was 100% among 8 patients where one-year follow-up was complete at the time of report.

Conclusions

Among patients BTT using ECMO, low SA, high BUN and AST are adverse prognostic variables and survival worsens with increasing number of laboratory abnormalities. Although the rate of successful BTT in the current series was just above 50%, higher-than-expected one-year survival may reflect better triaging of patients for LT while being bridged on ECMO.

CITATION INFORMATION: Batchelor E, Bland J, Douglass D, Mullins J, Mohanka M, Bollineni S, Kaza V, Wait M, Torres F, Banga A. Characteristics and Outcome of Patients Placed on Extracorporeal Membrane Oxygenation as Bridge to Lung Transplantation. Am J Transplant. 2016;16 (suppl 3).

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