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Functional Status Trends for Adults and Children on Extracorporeal Membrane Oxygenation at Time of Lung
Wonshill Koh1,2, JangDong Seo3, Nicholas J Ollberding4,5
1Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Wonshill.koh@cchmc.org.
Insights
Extracorporeal membrane oxygenation (ECMO) helps lung transplant candidates maintain or improve functional status while awaiting transplant. This vital support improves outcomes for critically ill patients needing lung transplantation.
Area of Science:
- Cardiology
- Pulmonology
- Transplantation Medicine
Background:
- Worsening functional status in lung transplant candidates increases mortality risk.
- Extracorporeal membrane oxygenation (ECMO) is increasingly used as a bridge to lung transplantation for critically ill patients.
- Maintaining functional status during the waitlist period is critical for lung transplant outcomes.
Purpose of the Study:
- To analyze the impact of ECMO on functional status in lung transplant candidates.
- To evaluate the efficacy of ECMO as a bridge to lung transplantation.
Main Methods:
- Analysis of the United Network for Organ Sharing Registry data.
- Assessment of functional status changes from waitlisting to lung transplantation in patients supported by ECMO.
Main Results:
- 70% of patients on ECMO successfully bridged to lung transplantation.
- 96% of adult lung transplant candidates on ECMO maintained or improved functional status.
- All pediatric lung transplant candidates on ECMO maintained or improved functional status.
Conclusions:
- ECMO is effective in supporting lung transplant candidates and maintaining or improving functional status.
- Advances in ECMO technology may further enhance functional status for transplant candidates.
- ECMO plays a crucial role in improving outcomes for critically ill lung transplant recipients.
Abstract:
Poor or worsening functional status of lung transplant (LTx) candidates is a key risk factor for waitlist and post-transplant mortality. As more critically ill adults and children are listed for LTx, the use of extracorporeal membrane oxygenation (ECMO) as bridge to LTx is also increasing. Sustaining optimal functional status while on the waitlist to LTx is crucial for LTx candidates as deterioration in functional status can negatively impact pre- and post-LTx outcomes. We conducted an analysis of the United Network for Organ Sharing Registry which showed that most patients (70%) on ECMO successfully bridged to LTx. The majority had severely limited functional status at the time of waitlisting but 96% of adults requiring ECMO on the waitlist for LTx either maintained or improved functional status from the time of waitlist to the time of LTx while all children on ECMO maintained or improved their functional status. With continuing medical and technical advances, the use of ECMO may also evolve to improve LTx candidates' functional status.
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