CHEST Guidelines-Rebuttal-From-Dr-Warren-et al

Rebuttal-From-Dr-Warren-et al_chest (1)

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The document discusses the debate surrounding the use of Extracorporeal Membrane Oxygenation (ECMO) as a bridge to transplant evaluation (BTTE) in patients with end-stage lung disease (ESLD) who are not yet listed for lung transplantation. The central issue is whether ECMO should be offered as life-saving therapy to these patients, potentially extending life or paving the way for a transplant.<br /><br />The main argument against using ECMO for BTTE is that it is not widely supported by expert opinion or standard practice, and it is only feasible at a limited number of specialized centers. The document references a study from Columbia University Medical Center, which only supports ECMO for patients already listed for lung transplantation, underscoring that ECMO for BTTE is rare.<br /><br />Moreover, many patients with advanced lung disease face delays in being referred to transplant centers, with many decompensating before they get a chance to be evaluated. The document suggests that criteria for using ECMO for BTTE are currently unrealistic, as transportation to an expert ECMO center for a thorough evaluation is often impractical.<br /><br />The rebuttal stresses that early referral and evaluation in ESLD is more vital than relying on ECMO for BTTE, citing that the real solution lies in increasing early transplant evaluation and advocacy for organ donation. It acknowledges the emotional challenges faced by both clinicians and patients in withholding potentially life-saving therapies but suggests focusing on broader systemic improvements for transplant readiness and organ availability.<br /><br />In conclusion, the document advises against the widespread use of ECMO as a bridge to transplant evaluation due to logistical challenges and emphasizes early referral and evaluation as a more viable approach.

Keywords

ECMO

bridge to transplant evaluation

end-stage lung disease

lung transplantation

Columbia University Medical Center

expert opinion

early referral

organ donation

transplant readiness

logistical challenges