Skip to main content

Spontaneously Breathing Extracorporeal Membrane Oxygenation Support Provides the Optimal Bridge to Lung Transplantation.

Publication ,  Journal Article
Schechter, MA; Ganapathi, AM; Englum, BR; Speicher, PJ; Daneshmand, MA; Davis, RD; Hartwig, MG
Published in: Transplantation
December 2016

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is being increasingly used as a bridge to lung transplantation. Small, single-institution series have described increased success using ECMO in spontaneously breathing patients compared with patients on ECMO with mechanical ventilation, but this strategy has not been evaluated on a large scale. METHODS: Using the United Network for Organ Sharing database, all adult patients undergoing isolated lung transplantation from May 2005 through September 2013 were identified. Patients were categorized by their type of pretransplant support: no support, ECMO only, invasive mechanical ventilation (iMV) only, and ECMO + iMV. Kaplan-Meier survival analysis with log-rank testing was performed to compare survival based on type of preoperative support. A Cox regression model was used to determine whether type of preoperative support was independently associated with survival, using previously established predictors of survival as covariates. RESULTS: Approximately 12,403 primary adult pulmonary transplantations were included in this analysis. Sixty-five patients (0.52%) were on ECMO only, 612 (4.93%) required only iMV, 119 (0.96%) were on ECMO + iMV, and the remaining 11,607 (94.6%) required no invasive support before transplantation. One-year survival was decreased in all patients requiring support, regardless of type. However, mid-term survival was similar between patients on ECMO alone and those not on support but significantly worse with patients requiring iMV only or ECMO + iMV. In multivariable analysis, ECMO + iMV and iMV alone were independently associated with decreased survival compared with nonsupport patients, whereas ECMO alone was not significant. CONCLUSIONS: In patients with worsening pulmonary disease awaiting lung transplantation, those supported via ECMO with spontaneous breathing demonstrated improved survival compared with other bridging strategies.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Transplantation

DOI

EISSN

1534-6080

Publication Date

December 2016

Volume

100

Issue

12

Start / End Page

2699 / 2704

Location

United States

Related Subject Headings

  • Waiting Lists
  • United States
  • Treatment Outcome
  • Time Factors
  • Surgery
  • Retrospective Studies
  • Respiration, Artificial
  • Respiration
  • Proportional Hazards Models
  • Middle Aged
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Schechter, M. A., Ganapathi, A. M., Englum, B. R., Speicher, P. J., Daneshmand, M. A., Davis, R. D., & Hartwig, M. G. (2016). Spontaneously Breathing Extracorporeal Membrane Oxygenation Support Provides the Optimal Bridge to Lung Transplantation. Transplantation, 100(12), 2699–2704. https://doi.org/10.1097/TP.0000000000001047
Schechter, Matthew Adam, Asvin M. Ganapathi, Brian R. Englum, Paul J. Speicher, Mani A. Daneshmand, R Duane Davis, and Matthew G. Hartwig. “Spontaneously Breathing Extracorporeal Membrane Oxygenation Support Provides the Optimal Bridge to Lung Transplantation.Transplantation 100, no. 12 (December 2016): 2699–2704. https://doi.org/10.1097/TP.0000000000001047.
Schechter MA, Ganapathi AM, Englum BR, Speicher PJ, Daneshmand MA, Davis RD, et al. Spontaneously Breathing Extracorporeal Membrane Oxygenation Support Provides the Optimal Bridge to Lung Transplantation. Transplantation. 2016 Dec;100(12):2699–704.
Schechter, Matthew Adam, et al. “Spontaneously Breathing Extracorporeal Membrane Oxygenation Support Provides the Optimal Bridge to Lung Transplantation.Transplantation, vol. 100, no. 12, Dec. 2016, pp. 2699–704. Pubmed, doi:10.1097/TP.0000000000001047.
Schechter MA, Ganapathi AM, Englum BR, Speicher PJ, Daneshmand MA, Davis RD, Hartwig MG. Spontaneously Breathing Extracorporeal Membrane Oxygenation Support Provides the Optimal Bridge to Lung Transplantation. Transplantation. 2016 Dec;100(12):2699–2704.

Published In

Transplantation

DOI

EISSN

1534-6080

Publication Date

December 2016

Volume

100

Issue

12

Start / End Page

2699 / 2704

Location

United States

Related Subject Headings

  • Waiting Lists
  • United States
  • Treatment Outcome
  • Time Factors
  • Surgery
  • Retrospective Studies
  • Respiration, Artificial
  • Respiration
  • Proportional Hazards Models
  • Middle Aged