Midterm outcomes of venovenous extracorporeal membrane oxygenation as a bridge to lung transplantation: Comparison with nonbridged recipients.

OBJECTIVES: Venovenous extracorporeal membrane oxygenation (VV-ECMO) is increasingly being used in acutely deteriorating patients with end-stage lung disease as a bridge to transplantation (BTT). It can allow critically ill recipients to remain eligible for lung transplants (LTx) while reducing pretransplant deconditioning. We analyzed early- and midterm postoperative outcomes of patients on VV-ECMO as a BTT and the impact of preoperative VV-ECMO on posttransplant survival outcomes. METHODS: All consecutive LTx performed at our institution between January 2012 and December 2018 were analyzed. After matching, BTT patients were compared with nonbridged LTx recipients. RESULTS: Out of 297 transplanted patients, 21 (7.1%) were placed on VV-ECMO as a BTT. After matching, we observed similar 30-day mortality between BTT and non-BTT patients (4.6% vs. 6.6%, p = .083) despite a higher incidence of early postoperative complications (need for ECMO, delayed chest closure, and acute kidney injury). Furthermore, preoperative VV-ECMO did not appear associated with 30-day or 1-year mortality in both frequentist and Bayesian analysis (odds ratio [OR]: 0.35, 95% confidence interval: 0.03-3.49, p = .369; OR: 0.27, 95% credible interval: 0.01-3.82, p = 84.7%, respectively). In sensitivity analysis, both subgroups were similar in respect to 30-day (7.8% vs. 6.5%, p = .048) and 1-year mortality (12.5% vs. 18%, p = .154). CONCLUSIONS: Patients with acute refractory respiratory failure while waiting for LTx represent a high-risk cohort of patients. VV-ECMO as a BTT is a reasonable strategy in adult patients with acceptable operative mortality and 1-year survival comparable to non-BTT patients.

Comment on Oehler et al. Outcome and Midterm Survival after Heart Transplantation Is Independent from Donor Length of Stay in the Intensive Care Unit. Life 2022, 12, 1053.

Oehler et al. described an interesting finding, stating that length of stay (LOS) of the donors in the intensive care unit (ICU) did not have an impact on the outcomes and survival of recipients up to 5 years after heart transplantation (HTx) [...].

Six-year prospective audit of 'scoop and run' for chest-reopening after cardiac arrest in a cardiac surgical ward setting.

OBJECTIVES: The aim of the study was to identify which cardiac surgical ward patients benefit from 'scoop and run' to the operating room for chest reopening. METHODS: In-hospital arrests in a cardiothoracic hospital were prospectively audited over a 6-year period. The following pieces of information were collected for every patient who was scooped to the operating room following cardiac arrest on the postoperative cardiac surgical wards: type of arrest, time since surgery, patient physiology before arrest, time to chest reopening, location of chest opening, surgical findings on reopening, time to cardiopulmonary bypass (if used) and patient outcomes. EXCLUSIONS: arrests in intensive care unit (ICU) and operating rooms. The primary outcome measure was survival to discharge from the hospital. RESULTS: There were 99 confirmed ward arrests in 97 cardiac surgical patients. The overall survival rates to discharge and at 1 year were 53.6% (52 of 97 patients) and 44.3% (43 of 97 patients), respectively. Twenty-one of the 97 (21.6%) patients underwent scoop and run to the operating room or ICU. Five of 12 daytime 'scoop and runs' survived to discharge, whereas none of nine survived where scoop and run was undertaken at night (P < 0.05). There was a trend towards increased survival when 'scoop and run' was undertaken following ventricular fibrillation/pulseless ventricular tachycardia arrests (P = 0.06) and in younger patients (P = 0.12) but neither achieved statistical significance. The median time out from surgery of survivors was 4 days (range 2-14 days). The median time to chest opening in survivors was 22 min. Cardiopulmonary bypass was utilized in four of five survivors. The median ICU and hospital lengths of stay were 176 h (range 34-857) and 28 days (range 13-70), respectively. CONCLUSIONS: The key determinant of a favourable 'scoop and run' outcome was whether the arrest occurred during daytime or night-time hours (P < 0.05). Despite a median time to chest opening of 22 min, all five survivors were discharged neurologically intact. The median time from surgery in these survivors was 4 days. Because of the risk of hypoxic brain damage, 'scoop and run' should be restricted to patients suffering witnessed arrests. The study has potential implications for resuscitation training and out-of-hours medical staffing in cardiothoracic hospitals.