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Original Research: Transplantation |

Organ Allocation Waiting Time During Extracorporeal Bridge to Lung Transplant Affects OutcomesExtracorporeal Bridge to Lung Transplant

Stefania Crotti, MD; Giorgio A. Iotti, MD; Alfredo Lissoni, MD; Mirko Belliato, MD; Marinella Zanierato, MD; Monica Chierichetti, MD; Guendalina Di Meo, MD; Federica Meloni, PhD; Marilena Pappalettera, MD; Mario Nosotti, MD; Luigi Santambrogio, MD; Mario Viganò, MD; Antonio Braschi, MD; Luciano Gattinoni, MD
Author and Funding Information

From Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore (Drs Crotti, Lissoni, and Chierichetti), Operative Unit for Thoracic Surgery and Lung Transplantation (Drs Nosotti and Santambrogio), and Respiratory Medicine Section, Dipartimento Toraco-Polmonare e Cardiocircolatorio, Università degli Studi (Dr Pappalettera), Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico of Milan; Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche (Dr Gattinoni), Università degli Studi, Milan; Anestesia e Rianimazione 2 (Drs Iotti, Belliato, and Di Meo), Anestesia e Rianimazione 1 (Drs Zanierato and Braschi), Pneumologia (Dr Meloni), and Cardiochirurgia (Dr Viganò), Fondazione IRCCS Policlinico S. Matteo, Pavia; and Dipartimento di Medicina Molecolare (Dr Meloni), Dipartimento di Scienze Clinico-chirurgiche, Diagnostiche e Pediatriche (Dr Braschi) Università degli Studi, Pavia, Italy.

Correspondence to: Stefania Crotti, MD, Department of Anesthesia and Intensive Care, Intensive Care Unit “E.Vecla,” Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, 20121, Italy; e-mail: stefania.crotti@policlinico.mi.it


Funding/Support: This study was partially funded by the Regione Lombardia “Project for Independent Research in the Intensive Care Field” [13465/2010].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(3):1018-1025. doi:10.1378/chest.12-1141
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Background:  The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplant (LTX) is still being debated.

Methods:  We performed a retrospective two-center analysis of the relationship between ECMO bridging duration and survival in 25 patients. Further survival analysis was obtained by dividing the patients according to waiting time on ECMO: up to 14 days (Early group) or longer (Late group). We also analyzed the impact of the ventilation strategy during ECMO bridging (ie, spontaneous breathing and noninvasive ventilation [NIV] or intubation and invasive mechanical ventilation [IMV]).

Results:  Seventeen of 25 patients underwent a transplant (with a 76% 1-year survival), whereas eight patients died during bridging. In the 17 patients who underwent a transplant, mortality was positively related to waiting days until LTX (hazard ratio [HR], 1.12 per day; 95% CI, 1.02-1.23; P = .02), and the Early group showed better Kaplan-Meier curves (P = .02), higher 1-year survival rates (100% vs 50%, P = .03), and lower morbidity (days on IMV and length of stay in ICU and hospital). During the bridge to transplant, mortality increased steadily with time. Considering the overall outcome of the bridging program (25 patients), bridge duration adversely affected survival (HR, 1.06 per day; 95% CI, 1.01-1.11; P = .015) and 1-year survival (Early, 82% vs Late, 29%; P = .015). Morbidity indexes were lower in patients treated with NIV during the bridge.

Conclusions:  The duration of the ECMO bridge is a relevant cofactor in the mortality and morbidity of critically ill patients awaiting organ allocation. The NIV strategy was associated with a less complicated clinical course after LTX.

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