Awake Extracorporeal Membrane Oxygenation as Bridge to Lung Transplantation: A 9-Year Experience
Awake Extracorporeal Membrane Oxygenation as Bridge to Lung Transplantation: A 9-Year Experience
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DOI：
10.1016/j.athoracsur.2016.11.056
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发表时间：
2017-08-01
影响因子：
4.6
通讯作者：
Bacchetta, Matthew
中科院分区：
文献类型：
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作者：
Biscotti, Mauer;Gannon, Whitney D.;Bacchetta, Matthew
背景体外膜肺氧合（ECMO）被用作肺移植的桥梁，但影响其成功的特征知之甚少。这一大型单中心试验评估了ECMO在该环境中的实施和结果。收集了2007年1月1日至2016年7月10日在我们机构（纽约长老会医院/纽约哥伦比亚大学医学中心）接受ECMO作为肺移植桥梁的患者的数据。分析了人口统计学、基线特征、生存率和ECMO配置的数据。72例患者接受ECMO作为肺移植的桥梁。72例患者中，40例（55.6%）接受了移植手术，37例（92.5%）存活出院，21例（84.0%）存活2年。收缩力或血管加压支持（70% vs 93.8%; p = 0.011）、简化急性生理学评分（26.8 vs 30.5; p = 0.048）和Ambrost（80% vs 56.2%; p = 0.030）在接受肺移植的患者与未接受肺移植的患者之间存在显著差异。囊性纤维化患者比其他肺部疾病患者更可能有移植桥（47.5% vs 25%; p = 0.050）。50例患者（69.4%）实现了每日参与物理治疗。这项研究表明，接受ECMO作为肺移植的桥梁的患者的生存率良好，并且在等待肺移植的患者中使用ECMO时，实现了较高的物理治疗率和避免机械通气。这些患者中有一半以上成功过渡到肺移植，我们深入了解了影响患者结局的因素，包括患者选择、ECMO时机和患者管理。(C)2017胸外科医师协会
Background. Extracorporeal membrane oxygenation (ECMO) is used as a bridge to lung transplantation, but characteristics that influence its success are poorly understood. This large, single-center experience evaluated the implementation and outcomes of ECMO in this setting.Methods. Data were collected for patients at our institution (New York-Presbyterian Hospital/Columbia University Medical Center in New York) who received ECMO as a bridge to lung transplantation from January 1, 2007 through July 10, 2016. Data were analyzed for demographics, baseline characteristics, survival, and ECMO configuration.Results. Seventy-two patients received ECMO as a bridge to lung transplantation. Of the 72 patients, 40 (55.6%) underwent the transplantation procedure, 37 (92.5%) survived to discharge, and 21 (84.0%) survived for 2 years. Inotropy or vasopressor support (70% vs 93.8%; p = 0.011), Simplified Acute Physiology Score (26.8 vs 30.5; p = 0.048), and ambulation (80% vs 56.2%; p = 0.030) were significantly different between the patients who underwent lung transplantation and those who did not. Patients with cystic fibrosis were more likely to have a bridge to transplantation than patients with other lung diseases (47.5% vs 25%; p = 0.050). Daily participation in physical therapy was achieved in 50 patients (69.4%).Conclusions. This study demonstrated favorable survival in patients receiving ECMO as a bridge to lung transplantation and achieved high rates of physical therapy and avoidance of mechanical ventilation while ECMO was used in patients awaiting lung transplantation. With more than half of these patients successfully bridged to lung transplantation, we gained insight into the factors influencing patients' outcomes, including patient selection, timing of ECMO, and patient management. (C) 2017 by The Society of Thoracic Surgeons