222: Everyone Should Get a Chance: Successful vs. Unsuccessful ECMO Bridge to Lung Transplant

Background: Extracorporeal membrane oxygenation (ECMO) as a bridge to transplantation (BTT) is an effective strategy for lung transplant candidates failing maximized medical management. A significant proportion of patients are unsuccessfully bridged and undergo withdrawal of life-support. This study compares successfully and unsuccessfully bridged patients at a high-volume lung transplant center. Methods: All patients BTT on ECMO at Columbia University Medical Center (CUMC) between 01/2012 and 04/2023 were identified. Retrospective chart review was performed to collect patient characteristics and BTT outcomes. Multiple variable logistic regression was used to analyze the effect of different variables on the likelihood of a successful bridge. Results: Of 152 patients, 93 (61%) patients were successful BTT and 59 (39%) patients were unsuccessful BTT. One hundred-five patients were bridged using venoarterial (VA) ECMO and 47 patients were bridged using venovenous (VV) ECMO. Sixty-two of 105 (59%) patients on VA ECMO and 31/47 (66%) patients on VV ECMO were successful BTT (p=0.474). No significant statistical differences existed when comparing patient characteristics in successful or unsuccessful BTT. Reasons for unsuccessful BTT were most commonly multi-system organ failure (61%), cardiopulmonary arrest (7%) and debilitation (5%). In patients with group one and three pulmonary hypertension (PH), 52/84 patients (62%) on VA ECMO and 23/35 (66%) patients on VV ECMO were successful BTT (p=0.858). Conclusion: This study demonstrates there is no significant difference in characteristics, support mode and ECMO duration when comparing successful to unsuccessful ECMO BTT. Our data suggests most patients selected for lung transplantation are appropriate candidates for ECMO BTT.