Blog
About

74
views
0
recommends
+1 Recommend
0
shares
  • Review: found
Is Open Access

Review of 'Lessons learned from extracorporeal membrane oxygenation as a bridge to lung transplantation'

Bookmark
2
The paper did not tell the whole story of ECMO use as a bridge to lung transplant
Average rating:
    Rated 2.5 of 5.
Level of importance:
    Rated 2 of 5.
Level of validity:
    Rated 3 of 5.
Level of completeness:
    Rated 2 of 5.
Level of comprehensibility:
    Rated 2 of 5.
Competing interests:
None

Reviewed article

  • Record: found
  • Abstract: found
  • Article: found
Is Open Access

Lessons learned from extracorporeal membrane oxygenation as a bridge to lung transplantation

 Vladimir Shumaster (corresponding) ,  Oliver Jawitz,  David Yuh (2014)
Extracorporeal membrane oxygenation (ECMO) has been used infrequently as a bridge to lung transplantation due to lack of consensus and data regarding the benefits of such a strategy. We present data from the United Network of Organ Sharing (UNOS) database on the outcomes of patients bridged to lung transplantation with ECMO. We used the UNOS database to analyze data between January 1, 2000 and December 31, 2011. During this time 14,263 lung transplants were performed, of which 143 (1.0%) were bridged using ECMO. Patients on ECMO as a bridge to lung transplantation were compared to those transplanted without prior ECMO support. Demographics, survival rates, complications, and rejection episodes were compared between the two groups. The 30-day, 6-month, 1-year, 3-year, and 5-year survival rates were 69%, 56%, 48%, 26%, and 11%, respectively, for the ECMO bridge group and 95%, 88%, 81%, 58%, and 38% respectively, for the control group (p ≤ 0.01). The ECMO group incurred higher rate of postoperative complications, including airway dehiscence (4% vs. 1%, p ≤ 0.01), stroke (3% vs. 2%, p ≤ 0.01), infection (56% vs. 42%, p ≤ 0.01), and pulmonary embolism (10% vs. 0.6%, p ≤ 0.01). The length of hospital stay was longer for the ECMO group (41 vs. 25 days, p ≤ 0.01), and they were treated for rejection more often (49% vs. 36%, p = 0.02). The use of ECMO as a bridge to lung transplantation is associated with significantly worse survival and more frequent postoperative complications. Therefore, we advocate very careful patient selection and cautious use of ECMO.
    Bookmark

    Review information

    10.14293/S2199-1006.1.SOR-MED.ABG1R6.v1.RENCVP

    This work has been published open access under Creative Commons Attribution License CC BY 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Conditions, terms of use and publishing policy can be found at www.scienceopen.com.

    ScienceOpen disciplines:
    Keywords:

    Review text

    I would like to commend the authors for the effort to conduct this analysis. The manuscript was well-written. The methods, raw data and analyzed data were clearly presented. However, the major weakness of the paper is that the study was misconceived. Absolutely, the lessons should be learned from ECMO as a bridge to lung transplant. However, this analysis did not point to a meaningful direction. The authors should present the analysis of why and how the use of ECMO was successful/suggested for what patient conditions or avoided for what patient population (etiology). The comparative analysis of ECMO patients with other non-ECMO patients was off the chart. It was not a fair comparison. The patients on ECMO were sicker and more severe. Off course, the mortality and morbidity of these patients would be higher. A meaningful comparison should be made for the patients with the similar disease states. The conclusion that the use of ECMO as a bridge to lung transplantation is associated with significantly worse survival and more frequent postoperative complications is not accurate. The worse survival and more frequent postoperative complications perhaps are the consequence of sicker patients, rather than the ECMO. The use of ECMO in these patients is one of many factors to these patients.

    Comments

    Comment on this review