Venoarterial ECMO Improves Survival to Transplant in Interstitial Lung Disease

Extracorporeal Membrane Oxygenation Machine
Extracorporeal Membrane Oxygenation Machine
In patients with end-stage interstitial lung disease, there was a higher rate of survival to transplantation with venoarterial extracorporeal membrane oxygenation.

Venoarterial extracorporeal membrane oxygenation (ECMO) improved rates of survival while awaiting lung transplantation in individuals with end-stage interstitial lung disease and pulmonary hypertension (PH), according to a study recently published in The Annals of Thoracic Surgery.

This single-center, retrospective review included 50 participants with interstitial lung disease and PH, 31 of whom received venoarterial ECMO and 19 of whom received venovenous ECMO as bridge to transplantation (BTT) between 2010 and 2016. Cox proportional hazards modeling was used to compare factors of venovenous and venoarterial ECMO linked to survival to transplantation. 

There was a higher rate of survival to transplantation in the venoarterial ECMO group (P =.03), with participants showing a 59% lower risk for death than the venovenous ECMO group (hazard reduction, 0.41; P =.03). 

When venovenous ECMO participants were switched to venoarterial ECMO, they too showed an improved rate of survival compared with those who remained on venovenous ECMO (P =.03). Individuals on ECMO who could walk independently before transplantation were at 80% lower risk for death (hazard ratio, 0.20; P <.01).

The study researchers concluded that “[d]espite the increased risk of death for [interstitial lung disease]-[pulmonary hypertension] patients in our [organ procurement organizations] due to long wait times, this risk could be modified with ECMO BTT. Regardless of the severity of PH, [upper body venoarterial] ECMO provided more durable support compared to [venovenous] ECMO. [Upper body venoarterial] ECMO prevents pre-transplant deconditioning by improving ambulation, decreases the need for tracheostomies for mechanical ventilator support, and prolongs survival to transplantation.”

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Chicotka S, Pedroso FE, Agerstrand CL, et al. Increasing opportunity for lung transplant in interstitial lung disease with pulmonary hypertension [published online May 28, 2018]. Ann Thorac Surg. doi:10.1016/j.athoracsur.2018.04.068