The organ allocation waiting time during extracorporeal bridge to lung transplantation affects outcomes
Articolo
Data di Pubblicazione:
2013
Citazione:
The organ allocation waiting time during extracorporeal bridge to lung transplantation affects outcomes / S. Crotti, G.A. Iotti, A. Lissoni, M. Belliato, M. Zanierato, M. Chierichetti, G. Di Meo, F. Meloni, M. Pappalettera, M. Nosotti, L. Santambrogio, M. Viganò, A. Braschi, L. Gattinoni. - In: CHEST. - ISSN 0012-3692. - 144:3(2013 Sep), pp. 1018-1025. [10.1378/chest.12-1141]
Abstract:
ABSTRACT BACKGROUND: The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (LTX) is still debated. METHODS: We performed a retrospective two-center analysis on the relationship between ECMO bridging duration and survival in twenty-five patients. Further survival analysis was obtained by dividing the patients according to waiting time on ECMO: up to 14 days (Early) or longer (Late). We also analyzed the impact of the ventilation strategy during ECMO bridging, i.e. spontaneous breathing and non-invasive ventilation (NIV) or intubation and invasive mechanical ventilation (IMV). RESULTS: 17 out of 25 patients were transplanted (with 76% 1-year survival) while 8 patients died on bridge. In the 17 transplanted patients, mortality was positively related to waiting days until LTX (HR 1.12 per day, 95%CI 1.02-1.23, p=0.02) and the group Early showed better Kaplan-Meier curves (p=0.02), higher 1-year survival rates (100% versus 50% p=0.03) and lower morbidity (days on IMV, length of stay in ICU and hospital). During bridge to transplantation, mortality steadily increased 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=0.015) and 1-year survival (Early group 82 % versus Late 29%, p=0.015). Morbidity indices were lower in patients treated with NIV during bridge. CONCLUSIONS: The duration of bridge on ECMO is a relevant co-factor for mortality and morbidity of critically ill patients awaiting organ allocation. The NIV strategy was associated with a less complicated clinical course after LTX.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
membrane-oxygenation; exprerience; mortality; survival; novalung; score
Elenco autori:
S. Crotti, G.A. Iotti, A. Lissoni, M. Belliato, M. Zanierato, M. Chierichetti, G. Di Meo, F. Meloni, M. Pappalettera, M. Nosotti, L. Santambrogio, M. Viganò, A. Braschi, L. Gattinoni
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