The Annals of thoracic surgery · 2025
National Outcomes of Nonintubated Extracorporeal Membrane Oxygenation as a Bridge to Heart Transplantation.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Akbar Armaan F, Zhou Alice L, Kalra Andrew, Oak Atharv, Ruck Jessica M, Whitman Glenn J R, Cho Sung-Min, Kilic Ahmet
Аннотация
BACKGROUND: Nonintubated venoarterial extracorporeal membrane oxygenation (ECMO) has been described in patients with refractory cardiogenic shock, but there are limited data on outcomes of this technique as a bridge to heart transplantation. We investigated this practice in a national cohort.
METHODS: Adult heart recipients bridged with ECMO from October 18, 2018, to September 30, 2023, in the United Network for Organ Sharing database were categorized by use of ECMO alone (ECMO-only) and ECMO with mechanical ventilation (ECMO+VENT) at transplant. Between groups, we compared posttransplant stroke, acute rejection, need for dialysis, length of stay, and survival.
RESULTS: Of 857 recipients bridged with ECMO, 198 (23.1%) were bridged with ECMO+VENT and 659 (76.9%) were bridged with ECMO-only. ECMO-only vs ECMO+VENT recipients less frequently required intra-aortic balloon pump (18.8% vs 30.3%), more frequently were supported with a temporary ventricular assist device (26.6% vs 19.2%, P = .04), and had better pretransplant functional status. ECMO-only vs ECMO+VENT recipients had a lower likelihood of posttransplant stroke (6.2% vs 10.7%; adjusted odds ratio, 0.55; 95% CI, 0.31-0.97; P = .04) or needing posttransplant dialysis (24.7% vs 35.5%; adjusted odds ratio, 0.59; 95% CI, 0.40-0.87; P = .007). ECMO-only vs ECMO-VENT recipients also had shorter median length of stay (22 vs 26 days, P < .001) and higher posttransplant survival at 90 days (95.1% vs 91.1%; adjusted hazard ratio [aHR], 0.53; 95% CI, 0.29-0.98; P = .04), 1 year (91.2% vs 85.7%; aHR, 0.60; 95% CI, 0.37-0.98; P = .04), and 3 years (86.0% vs 77.6%; aHR, 0.63; 95% CI, 0.40-0.97; P = .04).
CONCLUSIONS: Nonintubated ECMO was associated with better peritransplant outcomes and better short- and long-term survival after transplant compared with ECMO with mechanical ventilation. We support extubating ECMO-bridged candidates before transplant when possible.
METHODS: Adult heart recipients bridged with ECMO from October 18, 2018, to September 30, 2023, in the United Network for Organ Sharing database were categorized by use of ECMO alone (ECMO-only) and ECMO with mechanical ventilation (ECMO+VENT) at transplant. Between groups, we compared posttransplant stroke, acute rejection, need for dialysis, length of stay, and survival.
RESULTS: Of 857 recipients bridged with ECMO, 198 (23.1%) were bridged with ECMO+VENT and 659 (76.9%) were bridged with ECMO-only. ECMO-only vs ECMO+VENT recipients less frequently required intra-aortic balloon pump (18.8% vs 30.3%), more frequently were supported with a temporary ventricular assist device (26.6% vs 19.2%, P = .04), and had better pretransplant functional status. ECMO-only vs ECMO+VENT recipients had a lower likelihood of posttransplant stroke (6.2% vs 10.7%; adjusted odds ratio, 0.55; 95% CI, 0.31-0.97; P = .04) or needing posttransplant dialysis (24.7% vs 35.5%; adjusted odds ratio, 0.59; 95% CI, 0.40-0.87; P = .007). ECMO-only vs ECMO-VENT recipients also had shorter median length of stay (22 vs 26 days, P < .001) and higher posttransplant survival at 90 days (95.1% vs 91.1%; adjusted hazard ratio [aHR], 0.53; 95% CI, 0.29-0.98; P = .04), 1 year (91.2% vs 85.7%; aHR, 0.60; 95% CI, 0.37-0.98; P = .04), and 3 years (86.0% vs 77.6%; aHR, 0.63; 95% CI, 0.40-0.97; P = .04).
CONCLUSIONS: Nonintubated ECMO was associated with better peritransplant outcomes and better short- and long-term survival after transplant compared with ECMO with mechanical ventilation. We support extubating ECMO-bridged candidates before transplant when possible.