Background: Previous studies have reported an association of worse outcomes among critically ill patients with failed extubation. However there is lack of data on characteristics and outcomes among patients with lung transplantation (LT) who develop this complication after their transplant surgery.

Methods: We reviewed charts of all patients who underwent lung transplantation at UT Southwestern Medical Center between January 2012 and December 2014 (n=186;age 56.2±13.3 yrs;M:F 109:77). Demographic and clinical variables before and after LT, including the last pre-LT 6 minute walk test (6MWT) and lung functions at one year post LT were recorded. Development of failed extubation (leading to reintubation and resumption of mechanical ventilation) after transplant surgery was the primary outcome variable. Variables were compared among patients with and without failed extubation.

Results: Incidence of failed extubation was 6.5% (12/186). Patients with failed extubation had significantly lower heart rate recovery (HRR, calculated as change in heart rate between the end of 6MWT and 1 minute post) on their last pre-LT 6MWT (median with IQR:10,5-14 vs 14,10-20; p=0.016) with 12 as the best cut-off on ROC analysis. Although, patients with failed extubation were more likely to be younger (median age 54 vs 58 years), African American (incidence among African American: 11.1%) and to have undergone bilateral LT (all 12 patients with failed extubation had bilateral LT), none of these associations were statistically significant. Other baseline variables such as medical co-morbidities, acuity of illness as reflected by the lung allocation score at match, need of bridging strategies including ECMO support, or need of cardiopulmonary bypass during the transplant did not have an association with failed extubation. Patients with failed extubation had significantly prolonged ICU and hospital length of stay, lower lung functions at one year (FEV₁:1.9,1.2-2.1 vs 2.3,1.7-3.1 L; p=0.045) and experienced significantly worse survival at one year (58.3% vs 90.2%;p=0.007) and three years post LT (33.3% vs 67.8%, p=0.025).

Conclusions: A significant proportion of LT patients experience failed extubation. Patients with a HRR<12 during the last pre-LT 6MWT are at increased risk of this complication. Early and late outcomes are significantly worse among patients with failed extubation after LT.

CITATION INFORMATION: Smith L., Kanade R., Mahan L., Bollineni S., Mullins J., Kaza V., Mohanka M., Wait M., Torres F., Banga A. Characteristics and Outcomes among Patients with Failed Extubation after Lung Transplantation Am J Transplant. 2017;17 (suppl 3).

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