Extracorporeal membrane oxygenation as a bridge to lung transplantation: what lessons might we learn from volume and expertise?

Abstract

Lowest volume centres have lowest survival and there exists a volume threshold at which better outcomes are achieved.

Bridging to lung transplantation with extracorporeal circulatory support: when or when not?

“…In a United Network for Organ Sharing (UNOS) review, Hayanga and colleagues (27) showed an adjusted hazard ratio for mortality of 2.74 for patients who were bridged to lung transplantation with ECMO in a low-volume center (i.e., 1-5 transplants/year) versus a high-volume center (i.e., >15 transplants/year). This is an important consideration and suggests that transportation from a low-volume center to a higher-volume center may be wise, from both a risk and quality standpoint.…”

Back to the roots? Dual cannulation strategy for ambulatory ECMO in adolescent lung transplant candidates: An alternative?

“…Therefore, ECMO is not considered a contraindication for lung transplantation in most, but still not all, centers. Recent data demonstrate 1‐year survival rates of >70% in patients successfully bridged to lung transplant using this novel concept and are comparable to those patients without ECMO support prior to lung transplantation …”

“…As we decided to use our DCS in these clinical settings, the cannulas ( 4,7,19 Comparable to other tertiary ECMO centers that implemented the ambulatory ECMO approach in their clinical settings, we started with a single cannula strategy using the Avalon© double-lumen cannula.…”

Extracorporeal membrane oxygenation in the pre and post lung transplant period

“…Of these 26 centers, 12 performed one or less transplant using ECLS, while 14 performed >1 lung transplant using ECLS as a bridge (24). Two recent studies examining the UNOS registry showed that the overall one-year survival of patients bridged to lung transplant using ECLS in centers with greater volumes and ECLS experience were significantly higher than those with lower volumes/experience (20,24). Likewise, several single-center studies have reported oneyear survivals similar to non-ECMO bridged patients (25)(26)(27)(28)(29).…”

“…Initial studies after the inception of LAS scoring noted that one-year outcomes in patients with higher LAS (17) and patients bridged with ECMO were lower (18,19). However, more recent studies analyzing the UNOS database have showed that outcomes in ECMO patient's post-lung transplant may be similar to non-ECMO patients, especially in centers with higher transplant volumes and experience (20,21).…”