Extracorporeal membrane oxygenation as a bridge vs. non‐bridging for lung transplantation: A systematic review and meta‐analysis

Wan, Xiaolian; Bian, Tao; Ye, SuGao; Cai, Peiquan; Yu, Zhen; Zhu, Jianrong; Zhang, Wen‐Xiong

doi:10.1111/ctr.14157

Cited by 8 publications

(7 citation statements)

References 32 publications

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“…Overall, mortality rates in our review are consistent with published experience on ECMO use as bridge to lung transplantation (74), but lower than reported in case series and major randomized controlled trials (RCTs) on ECMO for ARDS (75). It is possible that careful selection of ARDS patients for awake ECMO may have resulted in enrollment of low-risk patients only.…”

Section: Discussionsupporting

confidence: 88%

Extracorporeal Membrane Oxygenation Without Invasive Ventilation for Respiratory Failure in Adults: A Systematic Review*

Belletti,

Sofia,

Cicero

et al. 2023

Critical Care Medicine

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OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) is an advanced treatment for acute severe respiratory failure. Patients on ECMO are frequently maintained sedated and immobilized until weaning from ECMO, first, and then from mechanical ventilation. Avoidance of sedation and invasive ventilation during ECMO may have potential advantages. We performed a systematic literature review to assess efficacy and safety of awake ECMO without invasive ventilation in patients with respiratory failure. DATA SOURCES: PubMed, Web of Science, and Scopus were searched for studies reporting outcome of awake ECMO for adult patients with respiratory failure. STUDY SELECTION: We included all studies reporting outcome of awake ECMO in patients with respiratory failure. Studies on ECMO for cardiovascular failure, cardiac arrest, or perioperative support and studies on pediatric patients were excluded. Two investigators independently screened and selected studies for inclusion. DATA EXTRACTION: Two investigators abstracted data on study characteristics, rate of awake ECMO failure, and mortality. Primary outcome was rate of awake ECMO failure (need for intubation). Pooled estimates with corresponding 95% CIs were calculated. Subgroup analyses by setting were performed. DATA SYNTHESIS: A total of 57 studies (28 case reports) included data from 467 awake ECMO patients. The subgroup of patients with acute respiratory distress syndrome showed a pooled estimate for awake ECMO failure of 39.3% (95% CI, 24.0–54.7%), while in patients bridged to lung transplantation, pooled estimate was 23.4% (95% CI, 13.3–33.5%). Longest follow-up mortality was 121 of 439 (pooled estimate, 28%; 95% CI, 22.3–33.6%). Mortality in patients who failed awake ECMO strategy was 43 of 74 (pooled estimate, 57.2%; 95% CI, 40.2–74.3%). Two cases of cannula self-removal were reported. CONCLUSIONS: Awake ECMO is feasible in selected patients, although the effect on outcome remains to be demonstrated. Mortality is almost 60% in patients who failed awake ECMO strategy.

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Section: Discussionsupporting

confidence: 88%

Extracorporeal Membrane Oxygenation Without Invasive Ventilation for Respiratory Failure in Adults: A Systematic Review*

Belletti,

Sofia,

Cicero

et al. 2023

Critical Care Medicine

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“…The observed mortality rate in this study aligns with findings from two prior systematic reviews ( 30 , 31 ). An earlier meta-analysis revealed that patients receiving long-term ECMO-supported lung transplantation as bridging therapy had a worse prognosis compared to those not receiving ECMO.…”

Section: Discussionsupporting

confidence: 91%

Prognostic factors in lung transplantation after extracorporeal membrane oxygenation bridging therapy: a systematic review and meta-analysis

Zhu,

Zeng,

Lan

et al. 2024

J Thorac Dis

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Background Extracorporeal membrane oxygenation (ECMO) has recently emerged as a critical support system for lung function in patients awaiting lung transplantation. This meta-analysis investigates the prognostic factors of lung transplantation following ECMO bridging therapy. Methods A comprehensive search was conducted in PubMed, Cochrane Library, Embase, CINAHL, Web of Science, Scopus, and ProQuest databases from inception to August 11, 2023. Included were cohort or case-control studies focusing on prognostic factors of lung transplantation with ECMO bridging therapy. Data extraction was performed independently, and study quality was assessed. A meta-analysis was carried out using RevMan 5.4 and Stata17.0 software to aggregate mortality rates and pertinent prognostic factors of ECMO as a bridge to lung transplantation. Results The search identified eight trials encompassing 1,086 participants. The prognosis of patients undergoing lung transplantation with ECMO bridging was significantly associated with several factors: prolonged ECMO support [odds ratio 1.07, 95% confidence interval (CI): 1.02–1.12, I 2 =77%], deterioration in liver and kidney function (odds ratio 3.62, 95% CI: 2.37–5.54, I 2 =0%), and complications during ECMO (odds ratio 2.24, 95% CI: 1.45–3.44, I 2 =5%). Conclusions Prolonged ECMO support, declining liver and kidney functions, and complications during ECMO are vital prognostic factors in lung transplantation following ECMO bridging therapy.

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“…However, in a recent meta-analysis comparing non-bridged and ECMO-bridged LTx patients using 19 studies, non-bridged LTx patients showed better 1-year to 5-year survival rates and fewer complications compared with the ECMO-bridged LTx patients [ 20 ]. In summary, whether ECMO as a bridge to LT can achieve survival rates similar to those of non-bridged LTx patients remains controversial.…”

Section: Outcome Of Ecmo As a Bridge To Ltxmentioning

confidence: 99%

“…The results of multivariate analysis in previous meta-analysis study showed that awake status (relative risk [RR], 2.7; 95% confidence interval [CI], 1.29–5.65), extubated on ECMO (RR, 5.39; 95% CI, 0.79–36), and ambulation (RR, 7.58; 95% CI, 2.16–26.62) were predictors of successful bridge to LTx [ 20 ]. Consistent with these factors, several studies have reported positive results associated with the use of ECMO as a bridge to LTx, such as awakening, minimal sedation, spontaneous breathing, and physical activity during ECMO [ 11 , 16 , 21 ].…”

Section: Outcome Of Ecmo As a Bridge To Ltxmentioning

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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Extracorporeal membrane oxygenation as a bridge vs. non‐bridging for lung transplantation: A systematic review and meta‐analysis

Cited by 8 publications

References 32 publications

Extracorporeal Membrane Oxygenation Without Invasive Ventilation for Respiratory Failure in Adults: A Systematic Review*

Extracorporeal Membrane Oxygenation Without Invasive Ventilation for Respiratory Failure in Adults: A Systematic Review*

Prognostic factors in lung transplantation after extracorporeal membrane oxygenation bridging therapy: a systematic review and meta-analysis

Awakening in extracorporeal membrane oxygenation as a bridge to lung transplantation

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