Abstract Rationale Right ventricular (RV) systolic dysfunction, ranging from subclinical to rapidly progressive cardiogenic shock, is a well-known yet difficult-to-manage complication during venovenous extracorporeal membrane oxygenation (VV ECMO) for hypoxemic respiratory failure. Among advanced lung disease patients undergoing VV ECMO as a bridge to lung transplantation (BTT), limited data exist regarding the incidence of and optimal strategies for defining and detecting RV dysfunction. The purpose of this study was to analyze the incidence and real-world patterns in detection of RV dysfunction in this unique population using transthoracic echocardiography (TTE). Methods A retrospective cohort study was conducted of BTT patients at a high-volume lung transplant center supported with VV ECMO as the initial configuration from 1/2020 to 10/2024. Baseline characteristics, data regarding patients’ hospital course, pre- and post-ECMO TTE data, and intraoperative transesophageal echocardiographic (TEE) data were analyzed. Continuous variables were compared using the Wilcoxon rank-sum test. Results Sixty-eight patients undergoing VV ECMO BTT were identified, with 199 total TTEs reviewed. Median age was 58 years (IQR, 47.5-64), 45.6% were female, and pulmonary fibrosis was the predominant transplant diagnosis (66.2%). Sixty-five patients (95.6%) had baseline pre-ECMO TTEs, performed a median 9 days (IQR, 4-22.5) prior to VV ECMO cannulation. 105 TTEs performed on VV ECMO were analyzed. The median number of TTEs performed per day on VV ECMO was 0.05 (IQR, 0-0.11). RV systolic function was most frequently graded by qualitative assessment (98.8%) and less consistently using quantitative measures (TAPSE 48.8%, RV S’ 6.5%, RV fractional area change 0.6%). Twenty-nine patients (42.6%) developed new or worsening RV systolic dysfunction and dilation on VV ECMO, respectively, though 13 patients (19.1%) had incomplete echocardiographic data for assessment (Table 1). Among patients with complete data, incidence of new RV dysfunction was 52.7% (29/55), with no difference in frequency of TTE examination per VV ECMO day between those who did and did not develop RV dysfunction (0.06 IQR, 0.05-0.2 vs. 0.07 IQR, 0.03-0.13, P=0.39). Conclusions A high incidence of new or worsening RV systolic dysfunction and dilation was observed among BTT patients supported by VV ECMO. TTE examination was infrequent, with median 1 TTE per 20 days on VV ECMO. No more frequent surveillance occurred among those who ultimately developed new RV dysfunction, which was predominantly graded by qualitative assessment. These findings highlight the need for rigorous prospective studies to design protocols for defining and detecting RV dysfunction during VV ECMO bridge to lung transplantation. This abstract is funded by: None
Daar et al. (Fri,) studied this question.