Background
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a key support modality
for cardiogenic shock. The 2018 United Network for Organ Sharing (UNOS) heart transplant
allocation algorithm prioritizes VA-ECMO patients.
Objective
To evaluate the role of VA-ECMO in bridging to advanced heart failure therapies.
Methods
We analyzed adult patients from the multicenter Extracorporeal Life Support Organization
registry receiving VA-ECMO for cardiac support or resuscitation between 2016 and 2021
in the United States, comparing bridge-to-transplant (BTT) and non-BTT intent patients,
as well as pre- vs post-2018 patients, on a wide range of demographic and clinical
outcome predictors.
Results
Of 17,087 patients, 797 received left ventricular assist device (LVAD)/heart transplant,
7,931 died or had poor prognosis, and 8,359 had expected recovery at ECMO discontinuation.
Patients supported with BTT intent had lower clinical acuity than non-BTT candidates
and were more likely to receive LVAD/transplant. The proportion of patients who received
VA-ECMO as BTT and received LVAD/transplant increased after 2018. Post-2018 BTT patients
had significantly lower clinical acuity and higher likelihood of transplant than both
post-2018 non-BTT patients and pre-2018 BTT patients. ECMO complications were associated
with lower likelihood of transplant but were significantly less common post-2018 than
pre-2018.
Conclusions
After implementation of the 2018 UNOS allocation system, ECMO utilization as BTT or
LVAD has increased, and the acuity of BTT intent patients cannulated for ECMO has
decreased. There has not yet been an increase in more acute ECMO patients getting
transplanted. This may partially explain the post-transplant outcomes of ECMO patients
in the current era reported in UNOS.
Keywords
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Article info
Publication history
Published online: February 28, 2023
Publication stage
In Press Journal Pre-ProofIdentification
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© 2023 International Society for Heart and Lung Transplantation. All rights reserved.
