Abstract
Background: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) therapy is being increasingly used as respiratory support for patients with severe coronavirus disease 2019 (COVID-19)associated acute respiratory distress syndrome (ARDS). However, the long-term outcome of VV-ECMO as a bridge to lung transplantation in COVID-19-associated ARDS remains unclear, hence the purpose of this study aimed to evaluate its long-term outcome, safety, and feasibility. Methods: This was a retrospective cohort study from an institutional lung transplantation database between June 2020 and June 2022. Data on demographics, pre-transplantation laboratory values, postoperative outcomes, preoperative and postoperative transthoracic echocardiography findings, and survival rates were collected. Chi-square, Mann-Whitney U, Student’s t, Kaplan-Meier, and Wilcoxon signed-rank tests were used for analysis. Results: Twenty-five patients with COVID-19-associated ARDS underwent lung transplant surgery with VV-ECMO bridge. Unfortunately, six patients with COVID-19-associated ARDS using VV-ECMO died while waiting for transplantation during the same study period. Patients with VV-ECMO bridge were a more severe cohort than 16 patients without VV-ECMO bridge (lung allocation score: 88.1 vs. 74.9, P<0.001). These patients had longer intensive care unit and hospital stays (P=0.03 and P=0.02, respectively) and a higher incidence of complications after lung transplantation. The one-year survival rate of patients with VV-ECMO bridge was lower than that of patients without (78.3% vs. 100.0%, P=0.06), but comparable to that of patients with other lung transplant indications (84.2%, P=0.95). Echocardiography showed a decrease in the right ventricular systolic pressure (P=0.01), confirming that lung transplantation improved right heart function. Conclusions: Our findings suggest that VV-ECMO can be used to safely bridge patients with COVID-19 associated ARDS with right heart failure.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 4417-4428 |
| Number of pages | 12 |
| Journal | Journal of Thoracic Disease |
| Volume | 16 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 30 2024 |
Funding
Peer Review File: Available at https://jtd.amegroups.com/ article/view/10.21037/jtd-24-132/prf Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups. com/article/view/10.21037/jtd-24-132/coif). A.B. was supported by the National Institutes of Health (HL145478, HL147290, and HL147575). The other authors have no The authors would like to thank Mrs. Kweli Pryor for her administrative assistance with the submission of this manuscript. Meeting Presentation: A summary of this study was presented at the 43rd Annual International Society for Heart and Lung Transplantation Meeting, April 19\u201322, 2023, Denver, CO, USA. Funding: This work was supported by the National Institutes of Health (HL145478, HL147290, and HL147575 to A.B.).
Keywords
- Lung transplantation
- acute respiratory distress syndrome (ARDS)
- coronavirus disease 2019 (COVID-19)
- extracorporeal membrane oxygenation (ECMO)
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine