Textbook Outcome in Lung Transplantation: Planned VA ECMO versus Off-Pump
1Duke University School of Medicine, Durham, NC, 2Anesthesiology, Duke University Medical Center, Durham, NC, 3Surgery, Duke University Medical Center, Durham, NC
Meeting: 2022 American Transplant Congress
Abstract number: 1475
Keywords: Lung transplantation, Outcome, Post-operative complications
Topic: Clinical Science » Lung » 64 - Lung: All Topics
Session Information
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: Planned venoarterial extracorporeal membrane oxygenation (VA ECMO) is increasingly used during bilateral orthotopic lung transplantation (BOLT) and may be superior to off-pump (OP) support for low-risk transplant recipients. To test this hypothesis, we compared rates of textbook outcome (TO), a novel composite quality metric, between BOLTs performed with planned VA ECMO versus OP support.
*Methods: Patients who underwent isolated BOLT at our center from 1/2017-2/2021 with planned OP or VA ECMO support were included. Those who had moderate or severe pulmonary hypertension (mean PA pressure ≥30 mmHg) or required concomitant cardiac surgery were excluded. Recipients were grouped based on listing support plans into OP and VA ECMO strata. TO was defined as freedom from 13 perioperative events shown in the Table. TO achievement rates and failure events were compared between groups using Chi-square tests and multivariable logistic regression.
*Results: 227 BOLT recipients were included: 62 planned VA ECMO and 165 OP. Compared to planned OP BOLTs, planned VA ECMO BOLTs were more likely to be redo transplants (14.5% vs 5.5%, p=0.02) and use DCD donor lungs (24.2% vs 10.3%, p<0.01), and less likely to require unanticipated escalations in intraoperative support (3.2% vs 20.6%, p<0.01) (Figure). 14 (22.6%) planned VA ECMO and 24 (14.5%) planned OP patients achieved TO (p=0.15). After adjustment for redo status, lung allocation score, and ischemic time, patients undergoing BOLT with planned VA ECMO had significantly higher odds of TO (OR 3.50, 95% CI 1.46-8.59, p<0.01). Reasons for TO failure differed between groups: planned OP patients were more likely to be extubated >48 hours post-transplant whereas planned VA ECMO patients were more likely to require reintervention and postoperative ECMO (Table).
*Conclusions: At our center, planned VA ECMO for isolated BOLT was associated with improved odds of TO compared to planned OP support. Planned use of VA ECMO may be preferred for low-risk patients; however further study in a national cohort is warranted to better elucidate the utility of this strategy.
To cite this abstract in AMA style:
Halpern SE, Wright MC, Madsen G, Chow B, Haney JC, Klapper JA, Bottiger BA, Hartwig MG. Textbook Outcome in Lung Transplantation: Planned VA ECMO versus Off-Pump [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/textbook-outcome-in-lung-transplantation-planned-va-ecmo-versus-off-pump/. Accessed May 18, 2025.« Back to 2022 American Transplant Congress