Impact of extracorporeal membrane oxygenation or mechanical ventilation as bridge to combined heart-lung transplantation on short-term and long-term survival.
BACKGROUND
Extracorporeal membrane oxygenation (ECMO) and mechanical ventilation (MV) can be used as a bridge to heart-lung transplantation (HLT). The goal of this study was to determine if pretransplantation ECMO or MV affects survival in HLT.


METHODS
The United Network for Organ Sharing database was reviewed for all adult patients receiving HLT from 1995 to 2011. The primary outcome measured was risk-adjusted all cause mortality.


RESULTS
There were 542 adult patients received HLT during the study period. Of these, 15 (2.8%) required ECMO and 22 (4.1%) required MV as a bridge to transplantation. The groups were evenly matched with regards to recipient age, recipient gender, ischemic time, donor age, and donor gender. The ECMO cohort had worse survival than the control group at 30 days (20.0% vs. 83.5%) and 5 years (20.0% vs. 47.4%; P<0.001). When compared with control, patients requiring MV had worse survival at 1 month (77.3% vs. 83.5%) and 5 years (26.5% vs. 47.4%; P<0.001). The use of ECMO (hazard ratio [HR]=3.820, 95% confidence interval [CI]=1.600-9.116; P=0.003) or MV (HR=2.011, 95% CI=1.069-3.784; P=0.030) as a bridge to transplantation was independently associated with mortality on multivariate analysis. Recipient female gender was associated with survival (HR=0.754, 95% CI=0.570-0.998; P=0.048).


CONCLUSIONS
HLT recipients bridged by MV or ECMO have increased short-term and long-term mortality. Further studies are needed to optimize survival in these high-risk patients.
1 Department of Surgery, Temple University School of Medicine, Philadelphia, PA. 2 College of Health Professions and Social Work, Temple University, Philadelphia, PA. 3 Section of Cardiothoracic Surgery, Department of Surgery, Temple University School of Medicine, Philadelphia, PA. 4 Section of Pulmonology and Critical Care, Department of Medicine, Temple University School of Medicine, Philadelphia, PA. 5 Address correspondence to: Yoshiya Toyoda, M.D., Temple University Hospital, Third Floor, Parkinson Pavilion, 3401 North Broad Street, Philadelphia, PA 19140.
Senthil N
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Jayarajan
Sharven
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Taghavi
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Komaroff
Stacey
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Tetsuya
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Francis
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Cordova
Namrata
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Patel
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Yoshiya
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Toyoda
D000328:Adult; D016009:Chi-Square Distribution; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D016041:Heart-Lung Transplantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012042:Registries; D012121:Respiration, Artificial / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists / Q000401:mortality*