A German Study published online in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine reveals that, extracorporeal membrane oxygenation (ECMO) support in awake, non-intubated patients may be an effective approach for bridging patients to lung transplantation.
Marius M. Hoeper, MD, professor of medicine at the Hannover Medical School in Hannover, Germany, explained:
"As waiting times for donor organs continue to increase, so does the need for bridging strategies for patients with end-stage lung disease awaiting transplantation.
Our study shows that ECMO support in awake and non-intubated patients may be an alternative to intubation and mechanical ventilation, and may result in better survival."
The retrospective, single-center study involved 60 individuals with terminal respiratory or cardiopulmonary failure. 34 patients in the control group received standard mechanical ventilation (MV) as a bridge to transplant, while 26 patients received awake ECMO. Median duration of patients on MV was 15 days (range 1-71) and 9 days (range 1-45) for those who received ECMO.
Veno-arterial ECMO was used mainly in patients with right ventricular failure and/or profound hypoxemia, while patients showing hypoxemic and/or hypercapnic respiratory failure but stable hemodynamics mainly received the veno-venous approach.
6 (23%) of the 26 patients in the ECMO group died before a donor organ became available, and 10 (29%) of the 34 patients in the MV group died. For patients in the ECMO who received transplantation, the survival rate at 6 months after transplantation was considerably (p=.02) higher (80%) than patients in the MV group (50%).
Among patients in the ECMO who required secondary intubation, the 6 month survival rate dropped to 43%. Patients in the ECMO group required considerably (p=.04) shorter postoperative mechanical ventilation and showed a trend towards shorter postoperative hospital stays.
Complications related to ECMO included:
- Intubation and mechanical was needed 1-7 days for ECMO insertion in 6 patients
- Fatal cardiac arrest following insertion of the venous ECMO cannulae in 1 patient
- 8 patients required blood transfusions
- Only 1 of the 5 patients who developed sepsis-like syndrome recovered
Lead author Thomas Fuehner, MD, explained:
"Ours is the largest series of patients who underwent awake ECMO as a bridge to lung transplantation. In addition to the possibility that this approach may improve survival, one of the main benefits of using awake ECMO is the avoidance of the complications associated with general anesthesia, intubation, and long-term ventilation."
Dr. Hoeper, said:
"Awake ECMO may be an effective bridging strategy for lung transplantation candidates. This strategy, however, remains investigational and must be studied further to improve its safety and efficacy and examine how to tailor its use for specific patient populations."
Written by Grace Rattue