Skip to main content
construction release_alert
Scholars@Duke will be undergoing maintenance April 11-15. Some features may be unavailable during this time.
cancel
Journal cover image

Implications of ECMO Bridging and Salvage Strategies on Mortality and PGD

Publication ,  Conference
Cantu, E; Bermudez, C; Cevasco, M; Suzuki, Y; Buckley, T; Galati, V; Majeti, N; Benvenuto, L; Anderson, M; Wille, KM; Weinacker, A; Dhillon, G ...
Published in: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
April 1, 2020

PURPOSE: ECMO is increasingly used for bridging and salvage therapies in lung transplantation, with favorable short-term results. Mid- to long-term outcomes of ECMO use for bridging and salvage are incompletely understood, as is effect on PGD risk; therefore, we sought to define the effects of these strategies on mortality and PGD. METHODS: The Lung Transplant Outcomes Group study is a multi-center prospective cohort study designed to identify risk factors for PGD and mortality. Patients were enrolled from August 2011 to June 2018. The effect of pre-operative (bridging) and post-operative (salvage) ECMO on Grade 3 PGD incidence and long-term survival were assessed using time-to-event analyses adjusted for center. RESULTS: 1,537 subjects were enrolled with a 17.0% incidence of PGD on day 3 and an 18.9% mortality overall. PGD was associated with mortality (p=0.0001, Fig. 1a). ECMO bridging and salvage strategies increased over time (Fig. 1b). 138 (9%) subjects had bridging ECMO and 275 (17.9%) had salvage ECMO. PGD was associated with bridging strategies (p=0.001). PGD incidence in bridged patients (50.7%) exceeded non-bridged (42.2%). Bridging was not associated with mortality overall (p=0.70, Fig. 1c); however, if PGD developed after transplant using a bridging strategy, there was a significant increase in mortality (HR 1.8 [1.3; 2.61]; p=0.0007). About 45% of patients bridged with ECMO required salvage after transplant. ECMO use for salvage was highly associated with mortality (HR 2.1 [1.6; 2.8]; p<0.0001, Fig. 1d). CONCLUSION: Use of the ISHLT Revised definition identifies Grade 3 PGD as highly associated with mortality in the ECMO bridging and salvage era. ECMO use is increasing for both bridging and salvage strategies. ECMO bridging strategies do not seem to increase mortality in lung transplant patients unless Grade 3 PGD subsequently develops. ECMO salvage after transplant is associated with increased risk of mortality; however, it is likely used only in the severest cases, thus indication bias is likely present.

Duke Scholars

Published In

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

DOI

EISSN

1557-3117

Publication Date

April 1, 2020

Volume

39

Issue

4

Start / End Page

S103 / S104

Related Subject Headings

  • Surgery
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Cantu, E., Bermudez, C., Cevasco, M., Suzuki, Y., Buckley, T., Galati, V., … Christie, J. (2020). Implications of ECMO Bridging and Salvage Strategies on Mortality and PGD. In The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (Vol. 39, pp. S103–S104). https://doi.org/10.1016/j.healun.2020.01.960
Cantu, E., C. Bermudez, M. Cevasco, Y. Suzuki, T. Buckley, V. Galati, N. Majeti, et al. “Implications of ECMO Bridging and Salvage Strategies on Mortality and PGD.” In The Journal of Heart and Lung Transplantation : The Official Publication of the International Society for Heart Transplantation, 39:S103–4, 2020. https://doi.org/10.1016/j.healun.2020.01.960.
Cantu E, Bermudez C, Cevasco M, Suzuki Y, Buckley T, Galati V, et al. Implications of ECMO Bridging and Salvage Strategies on Mortality and PGD. In: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2020. p. S103–4.
Cantu, E., et al. “Implications of ECMO Bridging and Salvage Strategies on Mortality and PGD.” The Journal of Heart and Lung Transplantation : The Official Publication of the International Society for Heart Transplantation, vol. 39, no. 4, 2020, pp. S103–04. Scopus, doi:10.1016/j.healun.2020.01.960.
Cantu E, Bermudez C, Cevasco M, Suzuki Y, Buckley T, Galati V, Majeti N, Benvenuto L, Anderson M, Wille KM, Weinacker A, Dhillon G, Orens J, Shah P, Lama V, McDyer J, Snyder L, Palmer S, Hartwig M, Hage C, Singer J, Calfee C, Kukreja J, Greenland J, Ware L, Hsu J, Gallop R, Diamond J, Christie J. Implications of ECMO Bridging and Salvage Strategies on Mortality and PGD. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2020. p. S103–S104.
Journal cover image

Published In

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

DOI

EISSN

1557-3117

Publication Date

April 1, 2020

Volume

39

Issue

4

Start / End Page

S103 / S104

Related Subject Headings

  • Surgery
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology