Bridging to lung transplantation with double-lumen venovenous extracorporeal membrane oxygenation

Abstract

Background: Double-lumen venovenous extracorporeal membrane oxygenation may be used as a bridge to lung transplantation. Predictors of outcome with this strategy have not been well described. Methods: All patients with irreversible lung disease who developed acute pulmonary failure and required double-lumen venovenous extracorporeal membrane oxygenation as a bridge to decision or lung transplant at our institution were included in this study. Survival of the extracorporeal membrane oxygenation patients was compared with listed patients who did not require extracorporeal membrane oxygenation with lung allocation score in the highest 10% for the same period. Results: Fifteen patients (46 ± 17 years old) received double-lumen venovenous extracorporeal membrane oxygenation cannula. Mean length of extracorporeal membrane oxygenation support was 18.2 (1–60) days. Of these, seven patients were bridged to lung transplant, six died on extracorporeal membrane oxygenation, and two weaned to recovery. Amount of red blood cell transfusion was significantly higher (3.3 vs 18.5 U, p = 0.003) and lowest oxygen saturation was significantly lower in non-survivors (84.5% vs 66.3%, p = 0.002). Of the seven patients who were already listed for lung transplant at the onset of extracorporeal membrane oxygenation, five were transplanted. Overall survival to hospital discharge was 60%. Survival of patients with lung allocation score in the highest 10% (average lung allocation score 83.4) in the same period was 80%. Conclusion: Double-lumen venovenous extracorporeal membrane oxygenation cannula is a feasible option to bridge patients to decision or lung transplantation. Blood transfusion requirement and low oxygen saturation are markers of poor prognosis. Listing status at the time of cannulation and ambulation during extracorporeal membrane oxygenation support may be important indicators of good outcome.

Awake extracorporeal life support and physiotherapy in adult patients: A systematic review of the literature

“…Femoral-femoral cannulation ( n = 642/931) was received by 69% patients femoral-femoral cannulation ( n = 642/931) with either unilateral or bilateral approach, 14,19–23,25–31,33,34,37,39–41,43–46 of which 75.9% for the specific reported cohort of V-A (n=284/374) and 63.5% for the specific reported cohort of V-V support mode (n=290/457). The 31% (n=289/931) of population underwent upper body cannulation through jugular and axillary access, 19,24,26,30,34,35,37,40,42,45,47 represented by 17.4% (n=65/374) of the specific reported V-A cases and 36.5% (n=167/457) of the V-V cases respectively. ECMO and IMV duration were reported in 64.5% ( n = 747/1157) 14,19,20,22,24–27,29–35,37–41,43,44,46,47 and in 26.5% ( n = 306/1157) 22,25,27–29,33,34,41,43,44,46 of the overall included population, and the median values were 11.17 days (95% CI: 9.61–12.72) and 12.85 days (95% CI: 6.32–19.37), respectively.…”

Extracorporeal membrane oxygenation and lung transplantation

“…Such a cannulation will aid in mobilising patients once extubated, since the groin is free of cannula. Yanagida et al [46] described a series of 15 patients who underwent BTT with ECMO using a single DLC via right IJV, thereby demonstrating the feasibility of BTT using DLC for ECMO support. Cannulation using DLC can, rarely, be associated with injury to the superior vena cava (SVC) [45], right atrium (RA), or right ventricle (RV) [47], and therefore requires cautious placement under fluoroscopy or transesophageal echocardiography.…”

Selection Criteria for Lung Transplantation: Controversies and New Developments

“…101,106 Factors associated with poor outcome for patients on ECMO are need for transfusion (due to bleeding, mechanical hemolysis), hypoxemia, not being listed at the time of cannulation, inability to participate in physical therapy, prolonged duration of ECMO bridging, sedation, and mechanical ventilation. 104,107 Lung transplant centers who put emphasis on elimination of sedation (the socalled "awake" ECMO) and aggressive physical therapy tend to have better outcomes. 107 The number of BTT ECMO patients getting lung transplantation varies from 45 to 89%, with 1-year survival rates ranging from 69 to 88%, improving over the years.…”

“…104,107 Lung transplant centers who put emphasis on elimination of sedation (the socalled "awake" ECMO) and aggressive physical therapy tend to have better outcomes. 107 The number of BTT ECMO patients getting lung transplantation varies from 45 to 89%, with 1-year survival rates ranging from 69 to 88%, improving over the years. 101,[103][104][105]108,109 Still, a longer time of ICU and hospital stay is reported, along with a higher risk for ECMO-related Fig.…”