Mechanical ventilation and extracorporeal membrane oxygenation as a bridge to lung transplantation: Closing the gap
Mechanical ventilation and extracorporeal membrane oxygenation as a bridge to lung transplantation: Closing the gap
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DOI：
10.1016/j.healun.2019.06.026
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发表时间：
2019-10-01
影响因子：
8.9
通讯作者：
Abbas, Ghulam
中科院分区：
文献类型：
--
作者：
Hayanga, J. W. Awori;Hayanga, Heather K.;Abbas, Ghulam
背景技术背景：本研究的目的是检查结果和生存与机械通气（MV）和体外膜肺氧合（ECMO）作为桥梁肺transplantation（LT）使用国家registry.METHODS：器官共享联合网络数据库进行了分析，在2005年至2017年期间的收件人。根据移植前桥接将受体分为3组。多变量回归分析检查了桥接对LT后结局的影响，调整了临床特征，包括时代（早期= 2005-2011，晚期= 2012-2017）和中心volume.Results：有21,576名LT接受者：无桥接（n = 19,783），MV（n = 1,129）和ECMO（n = 664）。平均年龄为54 ± 15岁（41%为女性）。ECMO的使用在晚期显著增加（1% vs 5%，p < 0.001）。与无桥接相比，MV和ECMO患者围手术期结局的几率更大，包括呼吸机支持>48小时、急性排斥反应和透析。与ECMO相比，MV患者呼吸机支持>48小时（p = 0.003）、透析（p = 0.003）、术后ECMO（p = 0.006）的几率降低，重新插管的几率更大（p = 0.005）。MV组（危险比[HR] 1.45，p < 0.001）和ECMO组（HR 1.48，p < 0.001）患者的5年死亡率风险更高，但MV组和ECMO组无差异（HR 0.98，p = 0.817）。ECMO组的死亡风险在后期降低（HR 0.54，p = 0.006）。结论：在过去十年中，ECMO作为LT的桥梁增加了271%，而MV减少了38%。ECMO的生存率显著提高，现在相当于接受MV桥接的受者的生存率。这些结果表明，该患者队列中ECMO的使用、结局和安全性有所提高。(C)2019年国际心肺移植学会。All rights reserved.
BACKGROUND: The purpose of this study was to examine outcomes and survival with mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (LT) using a national registry.METHODS: The United Network for Organ Sharing database was analyzed for recipients in the period 2005 to 2017. Recipients were categorized into 3 groups based on pre-transplant bridging. Multivariable regression analyses examined the effect of bridging on post-LT outcomes adjusting for clinical characteristics, including era (early = 2005-2011, late = 2012-2017) and center volume.RESULTS: There were 21,576 LT recipients: no bridge (n = 19,783), MV (n = 1,129), and ECMO (n = 664). Mean age was 54 +/- 15 years (41% female). Use of ECMO increased significantly in the late era (1% vs 5%, p < 0.001). Compared with no bridge, patients with MV and ECMO had greater odds for peri-operative outcomes including ventilator support >48 hours, acute rejection, and dialysis. Patients with MV had reduced odds for ventilator support >48 hours (p = 0.003), dialysis (p = 0.003), post-operative ECMO (p = 0.006), and greater odds for reintubation (p = 0.005) compared with ECMO. Patients in both MV (hazard raio [HR] 1.45, p < 0.001) and ECMO (HR 1.48, p < 0.001) groups had greater risk for 5-year mortality, but MV and ECMO groups did not differ (HR 0.98, p = 0.817). Risk for mortality in the ECMO group decreased in the later era (HR 0.54, p = 0.006).CONCLUSIONS: ECMO as a bridge to LT has increased 271%, while MV has decreased 38% over the past decade. Survival with ECMO has significantly improved and is now equivalent to survival in recipients bridged on MV. These results suggest gains in use, outcomes, and safety of ECMO in this patient cohort. (C) 2019 International Society for Heart and Lung Transplantation. All rights reserved.