非插管体外膜肺氧合作为肺移植桥梁的应用及结果

Utilization and outcomes of nonintubated extracorporeal membrane oxygenation as a bridge to lung transplant.

作者信息

Zhou Alice L, Jennings Maria R, Akbar Armaan F, Ruck Jessica M, Oak Atharv, Kalra Andrew, Larson Emily L, Casillan Alfred J, Ha Jinny S, Merlo Christian A, Bush Errol L

机构信息

Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.

Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.

出版信息

J Heart Lung Transplant. 2025 Apr;44(4):661-669. doi: 10.1016/j.healun.2024.10.021. Epub 2024 Oct 30.

DOI:10.1016/j.healun.2024.10.021

PMID:39486773

Abstract

BACKGROUND

Nonintubated extracorporeal membrane oxygenation (ECMO) has been increasingly utilized for patients with severe respiratory failure. Since data on its use as a bridge to lung transplant remain limited, we evaluated its use in a national cohort.

METHODS

Adult lung-only transplant recipients bridged with ECMO May 4, 2005 to March 8, 2023 in the United Network for Organ Sharing database were categorized by use of ECMO and mechanical ventilation (MV) at transplant (ECMO+MV vs ECMO-only). We compared post-transplant intubation and ECMO at 72 hours, length of stay, and survival.

RESULTS

The 1,599 transplants identified included 902 (56.4%) bridged with ECMO+MV and 697 (43.6%) bridged with ECMO-only. ECMO-only recipients had higher median age (52 vs 49 years, p < 0.001), shorter ischemic times (5.7 vs 6.0 hours, p = 0.003), and similar lung allocation scores (89.5 vs 89.6, p = 0.11). ECMO-only recipients had lower likelihood of intubation at 72 hours (56.5% vs 77.5%; adjusted odds ratio 0.33 [95% confidence interval (CI): 0.25, 0.42], p < 0.001) and shorter lengths of stay (28 vs 35 days; coefficient -0.19 [95% CI: -0.27, -0.11], p < 0.001). ECMO-only recipients had higher 90-day survival (92.1% vs 89.1%; adjusted hazards ratio (aHR) 0.69 [95% CI: 0.48, 0.99], p = 0.04) but similar 1-year (83.1% vs 81.5%; aHR 0.87 [95% CI: 0.67, 1.12], p = 0.27) and 5-year (54.6% vs 54.7%; aHR 0.98 [95% CI: 0.82, 1.17], p = 0.83) survival.

CONCLUSIONS

Nonintubated ECMO bridge to lung transplant was associated with improved perioperative outcomes and short-term survival and should be considered for candidates requiring ECMO.

摘要

背景

非插管体外膜肺氧合（ECMO）已越来越多地用于严重呼吸衰竭患者。由于其作为肺移植桥梁的使用数据仍然有限，我们评估了其在全国队列中的使用情况。

方法

2005年5月4日至2023年3月8日在器官共享联合网络数据库中接受ECMO桥接的成年单肺移植受者，根据移植时ECMO和机械通气（MV）的使用情况进行分类（ECMO+MV组与单纯ECMO组）。我们比较了移植后72小时的插管和ECMO情况、住院时间和生存率。

结果

确定的1599例移植中，902例（56.4%）接受ECMO+MV桥接，697例（43.6%）接受单纯ECMO桥接。单纯ECMO受者的年龄中位数较高（52岁对49岁，p<0.001），缺血时间较短（5.7小时对6.0小时，p=0.003），肺分配评分相似（89.5对89.6，p=0.11）。单纯ECMO受者在72小时时插管的可能性较低（56.5%对77.5%；调整后的优势比为0.33[95%置信区间（CI）：0.25，0.42]，p<0.001），住院时间较短（28天对35天；系数为-0.19[95%CI：-0.27，-0.11]，p<0.001）。单纯ECMO受者的90天生存率较高（92.1%对89.1%；调整后的风险比（aHR）为0.69[95%CI：0.48，0.99]，p=0.04），但1年（83.1%对81.5%；aHR为0.87[95%CI：0.67，1.12]，p=0.27）和5年（54.6%对54.7%；aHR为0.98[95%CI：0.82，1.17]，p=0.83）生存率相似。