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Transplant Evidence Alert

The Transplant Evidence Alert provides a monthly overview of the 10 most important new clinical trials in organ transplantation, selected and reviewed by the Peter Morris Centre for Evidence in Transplantation (Oxford University).
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Impact of delayed veno-venous extracorporeal membrane oxygenation weaning on postoperative rehabilitation of lung transplantation: a single-center comparative study

J Artif Organs. 2022 Dec 8; doi: 10.1007/s10047-022-01376-7.

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a reliable and effective extracorporeal life support during lung transplantation (LTx). However, the clinical benefit of delayed VV-ECMO weaning remains unclear. The current study aims to investigate whether delayed weaning of VV-ECMO is more beneficial to the rehabilitation for lung transplant patients. Patients who underwent LTx with VV-ECMO between January 2017 and January 2019 were included. Enrollment of patients was suitable for weaning off ECMO immediately after surgery. Randomization was performed in the operating room. Postoperative outcomes were compared between the two groups. Besides, univariate and multivariable logistic regressions were performed to estimate risk of postoperative complications. Compared to VV-ECMO weaning immediately after LTx, delayed weaning was associated with shorter hospital length of stay (days, 31 vs. 46; P < 0.05), lower incidence of noninvasive ventilation (4.3% vs. 24.4%; P < 0.05), primary graft dysfunction (PGD) (6.4% vs. 29.3%; P < 0.05), atrial fibrillation (AF) (4.3% vs. 22%, P < 0.05), and respiratory failure (4.3% vs. 19.5%; P < 0.05). Multivariable logistic regressions revealed that VV-ECMO weaning after LTx was independently correlated with increased risk of developing PGD [odds ratio (OR), 5.97, 95% CI 1.16-30.74], AF (OR, 6.87, 95% CI 1.66-28.47) and respiratory failure (OR, 6.02, 95% CI 1.12-32.49) by comparison of delayed VV-ECMO weaning. Patients with delayed VV-ECMO weaning are associated with lower complications and short hospital length of stay, while it relates to longer mechanical ventilation. These findings suggest that delayed VV-ECMO after LTx can facilitate rehabilitation.

CET Conclusion
Reviewer: Mr Simon Knight, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford
Conclusion: This single centre study randomised recipients of lung transplants requiring veno-venous ECMO intra-operatively to immediate or delayed weaning of ECMO post-operatively. Delayed ECMO weaning was associated with shorter hospital stay, less primary graft dysfunction and lower incidence of non-invasive ventilation. Whilst the results appear significantly better in the delayed-weaning group, there are some methodical and reporting issues that should be noted. No primary outcome is defined, and no sample size calculation is presented. The method of randomisation is not reported. Outcomes are not clearly defined – for example, the definition of primary graft dysfunction used is not clear. Many of the outcomes showing significant improvement may be subject to treatment biases in the absence of blinding – such as use of non-invasive ventilation and discharge from hospital. The findings are certainly worthy of further investigation in a larger, multicentre sample with more robust design.
Methodological quality
Jadad score 1
Allocation concealment NO
Data analysis PER PROTOCOL
Study Details
Aims: This study aimed to evaluate the benefits of delayed weaning of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in lung transplant recipients.
Interventions: Participants were randomised into two groups: the intraoperative VV-ECMO group which included VVECMO weaning immediately after lung transplantation, or the intra- and postoperative group which involved delayed VV-ECMO weaning after lung transplantation.
Participants: 88 lung transplant recipients with VV-ECMO.
Outcomes: The main clinical outcomes of interest were duration of hospital and ICU stay, duration of mechanical ventilation, noninvasive ventilation, respiratory failure, high-flow oxygen mask (auxiliary ventilation after VV-ECMO weaning), and postoperative complications.
Follow Up: Not reported
Funding: Funding not described
Publication type: Randomised Controlled Trial
Organ: Lung
Language: English
Author email:
MeSH terms: Lung Transplantation