BACKGROUND

The purpose of this study was to examine outcomes and survival with mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (LT) using a national registry.

METHODS

The United Network for Organ Sharing database was analyzed for recipients in the period 2005 to 2017. Recipients were categorized into 3 groups based on pre-transplant bridging. Multivariable regression analyses examined the effect of bridging on post-LT outcomes adjusting for clinical characteristics, including era (early = 2005–2011, late = 2012–2017) and center volume.

RESULTS

There were 21,576 LT recipients: no bridge (n = 19,783), MV (n = 1,129), and ECMO (n = 664). Mean age was 54 ± 15 years (41% female). Use of ECMO increased significantly in the late era (1% vs 5%, p < 0.001). Compared with no bridge, patients with MV and ECMO had greater odds for peri-operative outcomes including ventilator support >48 hours, acute rejection, and dialysis. Patients with MV had reduced odds for ventilator support >48 hours (p = 0.003), dialysis (p = 0.003), post-operative ECMO (p = 0.006), and greater odds for reintubation (p = 0.005) compared with ECMO. Patients in both MV (hazard raio [HR] 1.45, p < 0.001) and ECMO (HR 1.48, p < 0.001) groups had greater risk for 5-year mortality, but MV and ECMO groups did not differ (HR 0.98, p = 0.817). Risk for mortality in the ECMO group decreased in the later era (HR 0.54, p = 0.006).

CONCLUSIONS

ECMO as a bridge to LT has increased 271%, while MV has decreased 38% over the past decade. Survival with ECMO has significantly improved and is now equivalent to survival in recipients bridged on MV. These results suggest gains in use, outcomes, and safety of ECMO in this patient cohort.

中文翻译：

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机械通气和体外膜充氧是通向肺移植的桥梁：缩小缝隙。

背景

这项研究的目的是使用国家注册中心检查机械通气（MV）和体外膜氧合（ECMO）作为通向肺移植（LT）的桥梁的结果和存活率。

方法

在2005年至2017年期间，分析了器官共享联合网络数据库中的收件人。根据移植前的桥接，将收件人分为3组。多变量回归分析检查了桥接对LT后结局（根据年龄（早期= 2005–2011，晚期= 2012–2017）和中心体积）进行临床调整的影响。

结果

共有21,576名LT接收者：无桥梁（n  = 19,783），MV（n  = 1,129）和ECMO（n  = 664）。平均年龄为54±15岁（41％为女性）。在晚期，ECMO的使用显着增加（1％对5％，p <0.001）。与无桥相比，MV和ECMO患者围手术期结局的机率更高，包括呼吸机支持> 48小时，急性排斥反应和透析。与 ECMO相比，MV患者呼吸机支持> 48小时（p  = 0.003），透析（p = 0.003），术后ECMO（p  = 0.006）的几率降低，并且再次插管的几率（p  = 0.005）。两种MV患者（危险比值[HR] 1.45，p<0.001）和ECMO（HR 1.48，p <0.001）组的5年死亡率较高，但MV和ECMO组没有差异（HR 0.98，p  = 0.817）。ECMO组的死亡风险在后来的时代有所降低（HR 0.54，p  = 0.006）。

结论

在过去十年中，ECMO作为连接LT的桥梁增加了271％，而MV减少了38％。ECMO的生存率已显着提高，现在相当于在MV上桥接的接受者的生存率。这些结果表明该患者队列中ECMO的使用，结局和安全性均有所提高。