Perioperative Cardiovascular and Cerebrovascular Outcomes in Recipients of ECMO Bridge to Lung Transplant

Background The use of ECMO as bridge to lung transplant (BTT) has increased over time. While one-year and overall survival have been reported to be similar with non-ECMO transplant recipients, there are limited data major adverse cardiovascular and cerebrovascular events (MACCE) and clinically relevant bleeding (CRB) events. In this study we sought to evaluate the incidence of perioperative MACCE and CRB in lung transplant recipients who underwent ECMO BTT. MethodsUsing the National Inpatient Sample from 2008 to 2019, we identified 5,254 lung transplant recipients who either received or did not require pre-transplant ECMO. Perioperative MACCE and CRB were compared between the two cohorts. Results Patients with ECMO BTT had a higher incidence of MACCE compared to non-ECMO patients (35% vs. 13.3%, p <0.0001) and CRB (34.5% vs 12.9%, p <0.0001). Recipients of pre-transplant ECMO for double lung transplant (n=158) were more likely to have perioperative MACCE and CRB as opposed to patients without pre-transplant ECMO (n=3,584) (adjusted odds ratio 2.69, p <0.0001; 95% CI 1.86-3.80). The ECMO BTT cohort were notably younger with less cardiac comorbidities and higher diagnoses of cystic fibrosis and ILD. Conclusion Our data indicate that lung transplant recipients who required ECMO BTT are at significantly higher risk of MACCE and bleeding events despite being younger with less comorbidities as opposed to those who did not require ECMO.