CLINICAL CHARACTERISTICS AND OUTCOMES WITH THE USE OF EXTRACORPOREAL MEMBRANE OXYGENATION FOR INTERSTITIAL LUNG DISEASE: SYSTEMATIC REVIEW AND META-ANALYSIS

SESSION TITLE: Outcomes and Opportunities: Lung Transplantation SESSION TYPE: Original Investigations PRESENTED ON: 10/10/2023 01:45 pm - 02:45 pm PURPOSE: Extracorporeal membrane oxygenation (ECMO) has been increasingly used as a salvage support strategy as well as bridge to lung transplantation in patients with advanced interstitial lung disease (ILD). The indications, outcomes and complications in this patient population are limited in the existing literature. We did a systematic review and meta-analysis of the available studies to fill the knowledge gaps in the use of ECMO in advanced ILD. METHODS: We searched MEDLINE, Scopus, and Web of science until 22 Jan 2023 for observational studies, clinical trials and case series (> 5 adult patients) for the use of ECMO in the setting of ILD. We looked for the overall descriptive data as well as the prognostic factors associated with mortality in this setting. We conducted a separate meta-analysis of unadjusted and/ or adjusted odds ratio as well as hazard ratio if the data could not be extracted. RESULTS: A total of 1133 studies were identified, out of which 103 full-text studies were assessed for eligibility. 20 studies, all of them being retrospective observational studies, were included in the final analysis. 1359 patients with diagnosis of ILD were on ECMO (Venovenous (VV) ECMO 72.3%, Venoarterial (VA) ECMO 27.7%). The overall mean age was 54.72 ± 2.66 years with 67.23% males. The mortality of ILD patients on ECMO support was 52.2%. The mortality on VV ECMO was 56.21% and on VA ECMO was 39.4%. The unadjusted odds ratio (uOR) of mortality with the use of VV vs VA ECMO was 1.63 (95% CI 0.82 to 3.23, I2 = 0%, p=0.16). A total of 656 patients with diagnosis of ILD on ECMO were listed for lung transplant with mean age and standard error (SE) of 49.3 ± 3.0 years. The mean Lung Allocation Score and SE of 91.67 ± 1.29 and the mean post-transplant surgery ECMO days was 1.19 ± 1.16 days. The 30-day and 1 year survival of the patients who were supported on ECMO and underwent lung transplant was 83.9% (± 6.36) and 82.15% (± 50) respectively. In the transplant group, lower age (Mean difference ± SE -2.9 ± 1.27, 95% CI -5.41 to -0.436, p <0.021) but not LAS (-0.371 ± 0.81, -1.96 to 1.22, p=0.648) was statistically significant between survivors and non-survivors. CONCLUSIONS: The outcomes with the use of ECMO in the setting of ILD tends to be better with the younger age irrespective of the LAS and the use of type of ECMO support. The use of ECMO in advanced ILD is feasible with comparable outcomes to other indications for lung transplantation. CLINICAL IMPLICATIONS: Advanced ILD patients are benefited by ECMO support. It is important to focus on patient selection as well as ECMO timing to maximize the benefit of bridging to lung transplant. Well controlled prospective studies are essential in this patient population given the increased acceptance of the ECMO in day-to-day critical care practice. DISCLOSURES: No relevant relationships by Hassan Baig No relevant relationships by Prasanth Balasubramanian No relevant relationships by Maher Baz No relevant relationships by Anirban Bhattacharyya No relevant relationships by Sanjay Chaudhary No disclosure on file for Manoj Ghimire No relevant relationships by Pramod Guru No relevant relationships by Anek Jena No relevant relationships by Neal Patel No relevant relationships by Harsha Pattnaik No relevant relationships by Hollie Saunders