Use of ECMO as bridge to lung transplantation in children increased over time

The use of extracorporeal membrane oxygenation support as a bridge to lung transplantation in children increased in the U.S. from 2004 to 2019, researchers reported in Annals of the American Thoracic Society.

“ECMO used as a bridge to lung transplantation in pediatric patients has steadily increased in the last 15 years. ... Recent advances in ECMO care have resulted in an increasing use of ECMO and a progressive decline in the use of [mechanical ventilation] alone as a bridge to lung transplantation in children,” Kyle Thompson, MD, surgical research fellow in the department of general surgery at Boston Children’s Hospital, and colleagues wrote. “Despite its increase in use, ECMO as a bridge to transplantation is associated with increased in-hospital mortality after lung transplantation compared with those that required [mechanical ventilation] alone or no mechanical support at the time of transplant.”

Researchers identified 1,014 patients aged 20 years and younger in the United Network for Organ Sharing who underwent lung transplantation from January 2004 to August 2019. Lung transplant recipients received ECMO (6.7%; mean age, 17 years), mechanical ventilation (14.2%; mean age, 6 years) or neither (79.1%; mean age, 16 years) as a bridge to transplant.

Among those who received ECMO, the primary diagnoses included cystic fibrosis (43%), pneumonia and/or acute respiratory distress syndrome (10.3%), interstitial pulmonary fibrosis (7.4%) and pulmonary hypertension (5.9%).

ECMO use increased over time from 0% in 2004 to 16.7% in 2018.

Bridging with ECMO (adjusted OR = 3.57; 95% CI, 1.42-8.97) and mechanical ventilation (aOR = 2.67; 95% CI, 1.26-5.57) was associated with increased in-hospital mortality after lung transplantation in multivariable analyses.

Researchers reported no difference in the composite outcome of 1-year and 5-year mortality and re-transplantation rates between patients who received ECMO, mechanical ventilation or neither.

“Future research in ECMO care — including awake ECMO, physical rehabilitation while on ECMO, restricted blood product use and improvements in ECMO anticoagulation — to facilitate it as a safe and efficacious bridge to lung transplantation is urgently needed,” the researchers wrote.