Critical Care before Lung Transplantation

Lee, Jin Gu; Park, Moo Suk; Jeong, Su Jin; Kim, Song Yee; Na, Sungwon; Kim, Jeongmin; Paik, Hyo Chae

doi:10.4266/acc.2018.00367

Cited by 6 publications

(7 citation statements)

References 55 publications

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“…The most significant risk factor for hospital-acquired pneumonia is mechanical ventilation, and prolonged intubation increases the risk of ventilator-associated pneumonia [ 34 ]. These infections increase the risk of failure of bridges to LTx in patients with end-stage lung disease and increase the risk of mortality after LTx [ 35 ]. A study of awake ECMO as a bridge to heart transplantation showed a lower incidence of pneumonia compared to non-awake ECMO group [ 36 ].…”

Section: Advantages Of Awake Ecmomentioning

confidence: 99%

Awakening in extracorporeal membrane oxygenation as a bridge to lung transplantation

Lee

2022

Acute Crit Care

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Although the rate of lung transplantation (LTx), the last treatment option for end-stage lung disease, is increasing, some patients waiting for LTx need a bridging strategy for LTx due to the limited number of available donor lungs. For a long time, mechanical ventilation has been employed as a bridge to LTx because the outcome of using extracorporeal membrane oxygenation (ECMO) as a bridging strategy has been poor. However, the outcome after mechanical ventilation as a bridge to LTx was poor compared with that in patients without bridges. With advances in technology and the accumulation of experience, the outcome of ECMO as a bridge to LTx has improved, and the rate of ECMO use as a bridging strategy has increased over time. However, whether the use of ECMO as a bridge to LTx can achieve survival rates similar to those of non-bridged LTx patients remains controversial. In 2010, one center introduced awake ECMO strategy for LTx bridging, and its use as a bridge to LTx has been showing favorable outcomes to date. Awake ECMO has several advantages, such as maintenance of physical activity, spontaneous breathing, avoidance of endotracheal intubation, and reduced use of sedatives and analgesics, but it may cause serious problems. Nonetheless, several studies have shown that awake ECMO performed by a multidisciplinary team is safe. In cases where ECMO or mechanical ventilation is required due to unavoidable exacerbation in patients awaiting LTx, the application of awake ECMO performed by an appropriately trained ECMO multi-disciplinary team can be useful.

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Section: Advantages Of Awake Ecmomentioning

confidence: 99%

Awakening in extracorporeal membrane oxygenation as a bridge to lung transplantation

Lee

2022

Acute Crit Care

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“…Most countries use lung allocation scores or priority organ allocation systems based on a combination of waitlist urgency and the probability of post-transplant survival. However, in South Korea, the priority of the organ allocation system of the government is predominantly determined by the emergency of a patient’s status, and this is justified by ethical principles [ 26 ]. For these reason, the percentage of patients requiring ECMO bridge to LTx is high, up to 26.5%.…”

Section: Discussionmentioning

confidence: 99%

Long- and short-term clinical impact of awake extracorporeal membrane oxygenation as bridging therapy for lung transplantation

et al. 2021

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Background As lung transplantation (LTx) is becoming a standard treatment for end-stage lung disease, the use of bridging with extracorporeal membrane oxygenation (ECMO) is increasing. We examined the clinical impact of being awake during ECMO as bridging therapy in patients awaiting LTx. Methods In this single-center study, we retrospectively reviewed 241 consecutive LTx patients between October 2012 and March 2019; 64 patients received ECMO support while awaiting LTx. We divided into awake and non-awake groups and compared. Results Twenty-five patients (39.1%) were awake, and 39 (61.0%) were non-awake. The median age of awake patients was 59.0 (interquartile range, 52.5–63.0) years, and 80% of the group was men. The awake group had better post-operative outcomes than the non-awake group: statistically shorter post-operative intensive care unit length of stay [awake vs. non-awake, 6 (4–8.5) vs. 18 (11–36), p < 0.001], longer ventilator free days [awake vs. non-awake, 24 (17–26) vs. 0 (0–15), p < 0.001], and higher gait ability after LTx (awake vs. non-awake, 92% vs. 59%, p = 0.004), leading to higher 6-month and 1-year lung function (forced expiratory volume in 1 s: awake vs. non-awake, 6-month, 77.5% vs. 61%, p = 0.004, 1-year, 75% vs. 57%, p = 0.013). Furthermore, the awake group had significantly lower 6-month and 1-year mortality rates than the non-awake group (6-month 12% vs. 38.5%, p = 0.022, 1-year 24% vs. 53.8%, p = 0.018). Conclusions In patients with end-stage lung disease, considering the long-term and short-term impacts, the awake ECMO strategy could be useful compared with the non-awake ECMO strategy.

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“…However, in South Korea, organ allocation is governed primarily by the urgency of a patient's status. [30].…”

Section: Discussionmentioning

confidence: 99%

The Role of Awake Extracorporeal Membrane Oxygenation as Bridging Therapy for Lung Transplantation: A Retrospective Cohort Study

Kim¹,

Kim²,

Leem³

et al. 2020

Preprint

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Background As lung transplantation (LTx) becomes a standard treatment for end-stage lung disease, bridging to LTx with extracorporeal membrane oxygenation (ECMO) is increasing during waiting time, for either rescue treatment or improving ability to rehabilitation before transplant. This study investigated post-operative outcomes in patients bridging to lung transplantation with ECMO, especially those receiving awake ECMO. Methods In this single-center study, we retrospectively reviewed 241 consecutive LTx patients between October 2012 and March 2019. Among them, 65 patients received ECMO support while waiting for LTx; these patients were analyzed according to their awakeness. Multivaribale logistic regression and Cox proportional hazard models were used to analyze variables associated awake strategy and mortality. Results Thirty-three patients (50.7%) were awake during bridging ECMO, and 32 patients (49.2%) were in sedative status. The median age of awake ECMO patients was 59.0 (IQR 54.0-63.0) years, and 63.1% of population was male. There were no significant differences between awake and non-awake ECMO patients with respect to age, comorbidities, APACHE II score, ECMO duration and ECMO blood flow. Awake group have better post-operative outcome in terms of statically shorter post-operative intensive care unit (ICU) length of stay (LOS) (awake vs. non-awake, 6 [4-9.5] vs. 16 [6-22], p = 0.004) and longer ventilator free days (VFDs) (awake vs. non-awake, 24 [11.0-25.0] vs. 0 [0.0-14.5], p = 0.001). Furthermore, the awake ECMO group had a significantly lower six-month mortality rate compared to the non-awake group (18.2% vs. 40.6%, p = 0.045). It was independent predictive factor for ability to gait after LTx ([OR] 4.128, 95% CI 1.094-15.572, p = 0.036). Conclusions Awake ECMO therapy could be useful for high-risk patients waiting for LTx, and might help shorten ICU LOS and improve survival benefit after LTx. Furthermore, awake ECMO was independent predictive factor for postoperative gaiting.

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Critical Care before Lung Transplantation

Cited by 6 publications

References 55 publications

Awakening in extracorporeal membrane oxygenation as a bridge to lung transplantation

Awakening in extracorporeal membrane oxygenation as a bridge to lung transplantation

Long- and short-term clinical impact of awake extracorporeal membrane oxygenation as bridging therapy for lung transplantation

The Role of Awake Extracorporeal Membrane Oxygenation as Bridging Therapy for Lung Transplantation: A Retrospective Cohort Study

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