Textbook outcome in lung transplantation: Planned venoarterial extracorporeal membrane oxygenation versus off-pump support for patients without pulmonary hypertension
Section snippets
Data sources and study population
We conducted a single-center retrospective cohort study using institutional and United Network for Organ Sharing (UNOS) data. Adult (age ≥18) patients who underwent isolated BOLT with planned off-pump or VA ECMO support at Duke University Hospital between January 1, 2017 and February 28, 2021 were included. Follow-up was closed in November 2021. Patients who underwent multiorgan or single LTx, had moderate or severe PH (mean pulmonary artery pressure [mPAP] ≥30 mmHg on most recent
Recipient, operative, and donor characteristics
A total of 237 adult, isolated BOLT recipients with no or mild PH were included. Of those, 68 (28.7%) and 169 (71.3%) were in the planned VA ECMO and planned off-pump strata, respectively. Consistent with our standard practice, 94.6% of BOLTs in our cohort were planned off-pump before February 2020; thereafter, 85.5% were planned VA ECMO (Figure S1). Compared to planned off-pump patients, planned VA ECMO patients were more likely to have undergone prior LTx (13.2% vs 5.3%, p = 0.04). Additional
Discussion
Sequential BOLT performed off-pump using single-lung ventilation has long represented the standard planned intraoperative support strategy for BOLT recipients without PH at many institutions, including ours.4,6 However, VA ECMO is increasingly used non-selectively for all patients undergoing BOLT.18 In this study, we characterized the perioperative recovery profile of patients without PH who underwent BOLT on planned VA ECMO using the composite TO measure. We found that planned VA ECMO was
Conclusions
In this single-center analysis, we found that planned use of VA ECMO for isolated BOLT was associated with higher odds of TO achievement than planned off-pump support among patients without PH. Amidst growing enthusiasm for nonselective use of VA ECMO as the standard planned intraoperative support strategy during BOLT, our findings provide promising new evidence to support broader adoption of this strategy to improve perioperative outcomes among patients without PH. Future studies should
Author contributions
Samantha E. Halpern: conception and study design, data collection, data analysis and interpretation, drafting of the manuscript, critical revision of the manuscript, approval of the version to be published. Mary C. Wright: conception and study design, data collection, data analysis and interpretation, critical revision of the manuscript, approval of the version to be published. Gabrielle Madsen: conception and study design, data collection, data interpretation, critical revision of the
Disclosure
The authors report no conflicts of interest.
Acknowledgments
Clinical data was abstracted from the electronic medical record and adjudicated through the work of Duke PDC Outcomes Research Team (PORT): Improving Outcomes Through Analytics Award. SEH is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number TL1TR002555. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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