Ponholzer F, Schwarz S, Jaksch P, Benazzo A, Kifjak D, Hoetzenecker K, Schweiger T. Duration of extracorporeal life support bridging delineates differences in the outcome between awake and sedated bridge-to-transplant patients.
Eur J Cardiothorac Surg 2022;
62:6653299. [PMID:
35916716 DOI:
10.1093/ejcts/ezac363]
[Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES
Traditionally, patients on bridge-to-transplant extracorporeal membrane oxygenation were kept sedated and intubated. However, awake bridging strategies have evolved during recent years. This study aims to elaborate differences in physical activity and postoperative outcomes after lung transplantation, depending on bridging strategy and duration.
METHODS
Bridged patients receiving lung transplantation between 03/2013-04/2021 were analyzed. Awake bridging was defined as a Richmond Agitation-Sedation Scale score of ≥-1 until 24 h before transplantation. Patients were grouped in awake and sedated cohorts.
RESULTS
A total of 88 patients (35 awake, 53 sedated bridging) were included. After lung transplantation, mobilization to standing position was achieved earlier in awake bridged patients (7 vs 15 days, p = <0.001). Postoperative ventilation time (247 vs 88 hours, p = 0.005) and intensive care unit stay (30 vs 16 days, p = 0.004) were longer in the sedated cohort. Awake patients with bridging duration >6 days showed shorter postoperative ventilation time (108 vs 383 hours, p = 0.003), less intensive care unit days (23 vs 36, p = 0.003) and earlier mobilization to standing position (9 vs 17 days, p = <0.001). In contrast, postoperative ventilation time, and days on intensive care unit in patients with bridge-to-transplant duration ≤6 days were comparable between cohorts. Mobilization to standing position was achieved faster in the awake (≤6 days) bridged cohort (5 vs 9 days, p = 0.024).
CONCLUSIONS
Despite the complex management of bridged patients, excellent survival rates after lung transplantation can be achieved. Especially in patients with more than one week on extracorporeal membrane oxygenation, awake bridging concepts are associated with significantly faster recovery.
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