Use of veno-venous extracorporeal membrane oxygenation as a bridge to lung transplantation in awake nonintubated patients

Abstract

Introduction Extracorporeal membrane oxygenation (ECMO) in awake nonintubated patients has been proposed as a new strategy for bridge patients with end-stage respiratory failure to lung transplantation (LTx) (1). Aim We describe our experience in the use Veno-Venous ECMO (VV-ECMO) as a bridging technique in a series of awake and spontaneously breathing patients. Methods Retrospective analysis of awake nonintubated patients who underwent VV-ECMO for end-stage respiratory failure. Results VV-ECMO was used as a bridge to LTx in eleven awake nonintubated patients (6 cystic fibrosis, 2 pulmonary fibrosis, 2 redo LTx and 1 connectivitis). Blood gas values before ECMO start were: pH 7.28 \ub1 0.1, PaCO2 79.5 \ub1 26.5 mmHg, P/F 157 \ub1 117. Pre-transplant ECMO duration was 11 \ub1 15 days. Nine patients (82%) were maintained awake and spontaneously breathing until LTx while 2 patients required intubation and MV after 5 and 11 days respectively. Ten patients (91%) were successfully bridged to transplantation, while 1 of the 2 patients who needed MV, severely deteriorated after intubation and was deemed unfit for transplantation. All patients underwent double lung transplants: in 6 patients (60%) VV-ECMO was maintained during surgery, while in 4 patients it was intra-operatively converted to Veno-Arterial ECMO. In all patients VV-ECMO was prolonged post-operatively to better evaluate the graft performance and allowed a protective ventilation in those patients who developed PGD (45%). Survival at six months was 80%. Conclusions Our series of patients confirms that the awake ECMO strategy is feasible and successful. Reference Fuehner T, Kuehn C, Hadem J, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med. 2012 Apr 1; 185(7): 763-8