Venoarterial Versus Venovenous Extracorporeal Membrane Oxygenation As Bridge to Lung Transplantation

BACKGROUND Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) has been used as a bridge to lung transplantation with acceptable outcomes. We hypothesized that VA ECMO, as part of a multidisciplinary ECMO program, yields similar outcomes as VV ECMO as a bridge in lung transplantation. METHODS Records of all patients who had undergone ECMO with the intention to bridge to lung transplantation at University of California Los Angeles from January 1, 2012 to March 31, 2020 were reviewed. Baseline characteristics, in-hospital outcomes, long-term survival, and freedom from bronchiolitis obliterans syndrome (BOS) were assessed. RESULTS During this interval, 58 patients were placed on ECMO with the intention to bridge to lung transplantation: 27 on VV ECMO, and 31 on VA ECMO with a median duration of 7 and 17 days of support, respectively(p=0.01). Successful bridge to lung transplantation occurred in 21(78%) VV and 26(84%) VA patients. Incidence of primary graft dysfunction III(PGD III) at 72 hours in the VV and the VA cohorts were 0% and 4%, respectively(p=0.99). In-hospital and 90-day survival of the VV and VA groups were 100% and 96%, respectively(p=0.99). Three-year survival of the two groups were not significantly different from a contemporary cohort of lung transplant recipients not bridged with ECMO. CONCLUSIONS VA and VV ECMO can both be used as a bridge to lung transplantation with high success, with short and medium-term survival similar to non-bridged lung transplant recipients. Both modes should be considered effective at bridging select candidates to lung transplantation.