Original article
General thoracic
Extracorporeal Circulatory Systems as a Bridge to Lung Transplantation at Remote Transplant Centers

https://doi.org/10.1016/j.athoracsur.2010.09.005Get rights and content

Background

Worsening of lung function in patients awaiting lung transplantation can lead to ventilation-refractory hypoxemia or hypercapnia and respiratory acidosis. This report describes the successful use of different extracorporeal circulatory systems as a bridge to transplantation at remote centers.

Methods

Between January 2003 and December 2009, we had 10 requests for implantation of extracorporeal circulatory systems (pumpless extracorporeal lung assist [PECLA] or extracorporeal membrane oxygenation [ECMO]) in patients decompensating on the waiting list to bridge to transplantation at three different transplant centers between 150 km and 570 km apart. Cannulas were inserted percutaneously with Seldinger's technique.

Results

The median patient age was 36 years (range, 24 to 53). Three patients were supported with PECLA and 7 with ECMO. The median duration of support was 23 days (range, 5 to 73). Two patients were initially provided with ECMO and then changed to PECLA after hemodynamic stabilization in the face of persisting pulmonary failure. Two patients died of multiorgan failure on ECMO while on the waiting list. One PECLA patient was successfully weaned and waiting for LTx. Before transplantation, 5 patients (4 PECLA and 1 ECMO) were successfully weaned from mechanical ventilation, and 3 PECLA patients were successfully weaned from the system. Seven patients were successfully bridged and transplanted. Five of 7 patients were discharged from the transplant centers.

Conclusions

This report suggests that implantation of extracorporeal circulatory systems is a safe method to bridge patients decompensating on the waiting list for transplantation. Support intervals of several weeks are possible.

Section snippets

Patients and Methods

Between January 2003 and December 2009, the Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany, had 10 requests for implantation of ECS as a bridge to LTx in patients with ventilator-refractory hypoxemia or hypercapnia with accompanying severe respiratory acidosis. After approval by the local Ethics Committee, we reviewed data of these 10 patients.

Patients from regional hospitals who were potential ECS candidates were transferred to our center. If the patients

Results

During the observation period, 10 patients were considered for bridge to LTx. Eight patients were successfully implanted with an ECS device at our center. Two patients from outside hospitals were too unstable for conventional transport, and were placed on ECS at the referring hospital and then transported to our institution on active ECS. Patient characteristics are given in Table 1. The median age was 36 years (range, 24 to 53), and 70% were female. Before ECS implantation, all patients were

Comment

“Bridging” patients to LTx by extracorporeal devices has a history. In 1975, the first case of ECMO as a bridge to lung transplant was performed for posttraumatic respiratory failure [15]. In 1991, the Hannover group published the first report of long-term survival after using ECMO as a bridge to redo lung transplant [16]. From 1975 to the early 1990s, 7 patients underwent lung transplantation after ECMO application for acute severe respiratory failure, with disparate results [15, 16, 17].

References (28)

  • J.M. Smits et al.

    Predictors of lung transplant survival in Eurotransplant

    Am J Transplant

    (2003)
  • A. Geertsma et al.

    Does lung transplantation prolong life?A comparison of survival with and without transplantation

    J Heart Lung Transplant

    (1998)
  • A. Haneya et al.

    Extracorporeal circulatory systems in the interhospital transfer of critically ill patients: experience of a single institution

    Ann Saudi Med

    (2009)
  • C. Guérin

    Ventilation in the prone position in patients with acute lung injury/acute respiratory distress syndrome

    Curr Opin Crit Care

    (2006)
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