INTERVENTIONAL PULMONARY ASSISTANCE (iLA) AS A BRIDGE TO LUNG TRANSPLANTATION

INTRODUCTION According to the “International Society for Heart and Lung Transplantation” (ISHLT), between 1 and 4% of patients awaiting a lung transplant will need some type of respiratory assistance as a bridge to transplantation. The objective of this study is to analyze the results of patients assisted with the iLA “Interventional Lung Assist” system (Novalung®). MATERIAL AND METHODS The iLA respiratory assistance system (Novalung®) has been used in 12 patients as a bridge to lung transplantation (three chronic obstructive pulmonary disease, five obliterative bronchiolitis, two pulmonary fibrosis, one chest trauma, one pulmonary leiomyomatosis). The gasometric parameters that indicated the assistance were: PaO2: 76.1 ± 29; PaCO2: 110.6 ± 49; pH: 7.12 ± 0.1. The patients were anticoagulated with intravenous sodium heparin (aPTT 160-180 seconds). RESULTS Six hours after the start of respiratory assistance, the gasometric parameters were: PaO2: 89 ± 17 (p > 0.05); PaCO2: 54.6 ± 5 (p < 0.05); pH 7.34 ± 0.1 (p < 0.05). The mean time of attendance was 16.8 ± 8 (4-28) days. Of the total number of patients attended: one died during the care and the remaining 11 were transplanted, of which 8 survived the lung transplant. CONCLUSIONS Respiratory assistance using iLA (Novalung®) has proven to be an effective method as a bridge to lung transplantation. It allows to improve lung function and avoid mechanical ventilation. It is indicated in patients with nonpermissive hypercapnia to avoid mechanical ventilation. In mechanically ventilated patients, iLA assistance improves ventilator tidal volume, FiO2 and PEEP.

Mechanical Circulatory Support as a Bridge to Lung Transplantation: A Single Canadian Institution Review

Background. Lung transplant (LTx) waitlists continue to grow internationally. Consequently, more patients are progressing to require mechanical circulatory support (MCS) as a bridge to transplantation (BTT). MCS strategies include interventional lung assist (iLA) and venovenous (VV) and venoarterial (VA) extracorporeal membrane oxygenation (ECMO). We review our series of patients bridged with MCS while listed for LTx. Methods. All consecutive patients, listed for LTx requiring MCS as a BTT at the University of Alberta from 2004 to 2015, were included. Patient demographics and outcomes were compared for the 3 groups (iLA, VV-ECMO, and VA-ECMO). Results. Of the 24 patients supported with MCS devices, 17 were successfully transplanted and 7 died waiting. In total, 25% (n=6) were bridged with VA-ECMO, 54% (n=13) with VV-ECMO, and 21% (n=5) with iLA. Overall, 71% of patients were bridged successfully to LTx. The 1-year survival posttransplantation was 88%. Conclusion. We have demonstrated the feasibility of utilizing the MCS modalities of VA-ECMO, VV-ECMO, and most recently iLA, as a BTT. MCS is a viable strategy for BTT, offering improved survival outcomes for decompensating adult patients awaiting LTx, resulting in excellent survival posttransplantation.