Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Severance Hospital, Yonsei University College of Medicine, Postal address: 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Heart Lung. 2022 Nov-Dec;56:148-153. doi: 10.1016/j.hrtlng.2022.07.008. Epub 2022 Jul 28.
Incidence of complications related extracorporeal membrane oxygenation (ECMO) support as a bridge to lung transplantation (BTT) and its association with the patient outcome in lung transplantation (LT) has not been well documented in previous studies.
We evaluated the incidence of complications related to the use of ECMO support as a BTT, and the association between the occurrence of the complications and patient outcomes in LTs.
This retrospective cohort study investigated 100 consecutive patients who started ECMO support as a BTT between April 2013 and March 2020. Data for the analyses were retrieved from electronic medical records.
Fifty-six percent of the patients experienced at least one complication during the BTT with ECMO. Major bleeding was the most common complication. In multivariate logistic regression analysis, occurrence of oxygenator thromboses (OR 16.438, P = 0.008) and the use of renal replacement therapy (RRT) (OR 32.288, P < 0.001) were associated with a failed BTT. In the subgroup analysis of the LT recipients, intracranial hemorrhages, (OR 13.825, P = 0.021), RRT use, (OR 11.395, P = 0.038), and bloodstream infection occurrence (OR 6.210; P = 0.034) were identified as risk factors for in-hospital mortality.
The occurrence of complications during the use of ECMO support as a BTT was associated with unfavorable outcomes in LTs. Close monitoring and the proper management of these complications may be important to achieve better outcomes in patients using ECMO support as a BTT.
体外膜肺氧合（ECMO）支持作为肺移植（LT）桥接的并发症发生率及其与 LT 患者结局的关系在以前的研究中尚未得到很好的记录。
我们评估了使用 ECMO 支持作为 BTT 时发生并发症的发生率，以及这些并发症的发生与 LT 患者结局之间的关系。
这项回顾性队列研究调查了 2013 年 4 月至 2020 年 3 月期间开始使用 ECMO 支持作为 BTT 的 100 例连续患者。分析数据取自电子病历。
56%的患者在 ECMO 支持 BTT 期间至少经历了一次并发症。大出血是最常见的并发症。在多变量逻辑回归分析中，氧合器血栓形成的发生（OR 16.438，P=0.008）和肾脏替代治疗（RRT）的使用（OR 32.288，P<0.001）与 BTT 失败相关。在 LT 受者的亚组分析中，颅内出血（OR 13.825，P=0.021）、RRT 的使用（OR 11.395，P=0.038）和血流感染的发生（OR 6.210；P=0.034）被确定为住院死亡率的危险因素。
在使用 ECMO 支持作为 BTT 期间发生并发症与 LT 的不良结局相关。密切监测和适当管理这些并发症可能对使用 ECMO 支持作为 BTT 的患者获得更好的结局很重要。
