The Feasibility of Extracorporeal Membrane Oxygenation Support for Inter-Hospital Transport and as a Bridge to Lung Transplantation

Abstract

Background: Regional lung transplantation centers should be equipped with an inter-hospital transport program that can provide life-support for lung transplant candidates who develop acute respiratory failure outside the hospital. The purpose of this study was to assess the value of extracorporeal membrane oxygenation (ECMO) as a means of support during transport and as a bridge to lung transplantation for transplant candidates who develop respiratory failure outside the transplantation center.Methods: We retrospectively analyzed data from 7 patients who developed acute lung failure during treatment of end-stage lung diseases at other hospitals and for whom inter-hospital transport to the lung transplantation center at our hospital was requested between December 2011 and June 2013.Results: All 7 patients were treated with ECMO via a Terumo Emergency Bypass System^® (EBS^®) during transport, and all were transported without incident. There were no adverse events related to ECMO. All patients maintained stable vital signs during transport. Four patients received lung transplant within 10.5 ± 2.3 days (range: 7 to 12 days) after transport, 1 patient was weaned from ECMO without transplant, and 2 patients died with multi-organ failure while awaiting donor lungs.Conclusion: ECMO was useful for transfer of lung transplant candidates who developed acute respiratory failure at other institutions and as a bridge to lung transplantation. An inter-hospital transport program involving ECMO may increase the likelihood of successful transport to regional transplantation centers for lung transplantation candidates who show respiratory failure.