(981) Impact of VV ECMO Use as Bridge to Lung Transplant in Patients with COVID-19 Associated Acute Respiratory Distress Syndrome

PURPOSE: Lung transplantation is a potentially lifesaving treatment for critically ill patients with COVID-19-associated acute respiratory distress syndrome (ARDS). Many patients require extracorporeal membrane oxygenation (ECMO) as life-saving support when other traditional treatments fail. However, there is limited information regarding the long-term outcomes of VV-ECMO use as a bridge to lung transplantation in patients with ARDS. METHODS: This was a retrospective review of an institutional lung transplant database. We included consecutive lung transplant recipients between June 2020 and June 2022. Demographic, clinical, laboratory, treatment data, the outcomes of lung transplantation, and survival were collected and analyzed. Kaplan-Meier and Wilcoxon tests were used to evaluate survival rates. RESULTS: Among the 41 lung transplant recipients for COVID-19-associated ARDS, 25 patients (median age 53 years [IQR, 36-55]; 11 women [44.0%]) had ECMO bridges and 16 patients (median age 54.5 years [IQR, 52.75 to 63]; 7 women [43.8%]) did not. For lung transplant recipients with ECMO bridges compared to those without, the median lung allocation scores were 88.1 vs. 74.9 (p<0.001). During transplantation, patients with COVID-19-associated ARDS received transfusions with a median of ten units of packed red blood cells vs. two units in those without ECMO bridges; 96.0% vs. 93.8% underwent intraoperative venoarterial ECMO, and the median operative time was 9.5 hrs. vs. 7.8 hrs., respectively. Postoperatively, the rates of primary graft dysfunction grade 3, within 72 hrs., were 44% in the ECMO bridge vs. 0% in those without them. The median duration of intensive care unit stays was 20 days vs. 13 days, and the median post-lung transplant hospitalization duration was 35 days vs. 19.5 days, respectively. After follow-up (median follow-up period: 448 days [IQR, 314-664] in patients with ECMO bridges vs. 417 days [IQR, 389.5-506] in patients without them), one-year survival rates were 78.3% in patients with ECMO bridges and 100.0% in patients without (p=0.06). CONCLUSION: In this single-center case series of 41 consecutive patients who underwent lung transplantation for COVID-19-associated ARDS, patients on an ECMO bridge showed a more severe cohort. However, there was no significant difference in the overall outcomes between the two groups (p=0.06).