ECMO Application in Different Strategies and Techniques for Patients with End-Stage Respiratory Failure, Including COVID-19, Undergoing Lung Transplantation - 6-Year, Single Centre Experience

Ojectives: This article explores the use of ECMO therapy in patients with end-stage respiratory failure who need lung transplantation (LTx). ECMO has several roles: it can bridge patients to transplantation, condition the lung graft in case of primary graft dysfunction after transplantation, condition the the left ventricle after transplantation in patients with primary pulmonary hypertension, and manage COVID-19 patients who are awating LTx or undergoing LTx. Methods: We present 6-year results from high volume lung transplant center (219 cases/6years, >50 cases/2022). We used ECMO in 56 cases (25.6%) of all lung transplants be- tween 2018 and 2023. Results: The one-year survival rate of patients transplanted on ECMO was 85.7% (95%CI: 77.0-95.4%). We applied all advanced ECMO techniques, such as bridging to transplantation on ECMO (n=15, early survival 66.7%), left ventricular conditioning after LTX with VA-ECMO protocol (n=12, 60-day and one-year survival 85.1% and 53% respectively) and the most advanced variant of ECMO such as Sport-ECMO (n=7). We also bridged to transplantation patients with COVID-19 and were among the first in Europe to transplant them from ECMO (n=9, early survival 55%). Conclusions: This article shows possible applications of ECMO therapy for various indications in lung transplant patients and along with data from other publications it demonstrates that ECMO can improve survival and outcomes in patients with end-stage respiratory failure, primary pulmonary hypertension, and COVID-19. The COVID-19 pan- demic highlighted new utilization of ECMO,demonstrating its usefulness and importance in critical care medicine. Further research into the capabilities of the ECMO system may expand knowledge about its role in lung transplantation and future treatments.