Cannulation Configuration and Its Effects on Bridging to Lung Transplant: Analysis of the Extracorporeal Life Support Organization Registry.

Abstract

Donor stagnation and modification of lung allocation scores has resulted in a higher acuity of patient presentation before lung transplantation. Extracorporeal membrane oxygenation (ECMO) has been used as a bridge to lung transplant (BTT), although the effect of cannulation strategy on outcomes has not been well investigated. We analyzed contemporary data on ECMO BTT by using a large, international registry of patients. We used the Extracorporeal Life Support Organization registry to identify all adult patients from 2010 to 2022 undergoing ECMO as a BTT. Patients were stratified by venovenous or venoarterial support type. A total of 1066 patients were identified. ECMO BTT increased over the study period (P < .001), as did survival to hospital discharge (P < .001), with an overall survival of 87.7%. Venovenous patients experienced fewer complications on ECMO, including dialysis (16.7% vs 25.3%, P = .006), stroke (1.4% vs 5.1%, P = .004), and limb ischemia (0.2% vs 3.4%, P < .001) and required ECMO less frequently in the postoperative period (41.0% vs 53.4%, P = .002) and for less time (4 days [interquartile range, 2-7 days] vs 5 days [interquartile range, 3-9 days], P = .01). In-hospital mortality was significantly lower for venovenous patients compared with venoarterial patients (11.0% vs 18.5%, P = .005). Increasing center volume of ECMO BTT was protective of in-hospital mortality (P < .001), with benefit observed after ∼45 total BTT intent cannulations. ECMO BTT has resulted in improved posttransplant survival to discharge. Owing to a higher rate of complications and worsened mortality, thoughtful implementation of venoarterial ECMO in BTT should be undertaken when assessing patient candidacy.