Septic shock – A contraindication for bridge to transplant?

Aim: To show first results of patients in septic shock being bridged to lung transplantation (ltx) via extra corporal membrane oxygenation (ECMO). Methods: A retrospective, single-center study observing septic patients in 2012 and 2013 taken on ECMO and being transplanted. Results: 12 patients were included, 1 died on ECMO prior to ltx, 2 died in the first days post transplantation. 7 were female; the mean age was 46. 5 patients suffered from mucoviscidosis, 3 had fibrosis, 2 COPD and another 2 PAH respectively bronchiectasis. The mean time on the waiting list was 15.7 month, mean lung allocation score 90 points. With 8 patients the sepsis was classified as septic shock with the use of catecholamines. 5 patients had 4 SIRS points, 4 had 3 and 2 had 2 points (one was connected to ECMO prior to the transfer to our hospital). Mean time on ECMO was 35.5 days. Cannulation was in all patients veno-venous and had to be changed in veno-(veno)-arterial in 3 patients. 8 patients did not need ECMO after ltx. The mean time on ICU after ltx counted 44.5 days. Conclusion: Infection and even more sepsis are commonly seen as at least relative contraindications for taking patients on ECMO and bridging them to ltx. Main reasons are the high mortality rate of septic patients on ECMO and the worse outcomes after ltx. We were able to show that nearly all patients (11 from 12) could be bridged to ltx and the overall mortality rate was relatively low (3 out of 12 died). There was no major correlation between high SIRS points, more ECMO days or use of catecholamines and longer ICU stay or death. Further consideration of the data is needed, in order to identify clues for best outcomes in times of scarce resources.