Effect of duration of ECMO application on prolonged mechanical ventilation after lung transplantation in patients with idiopathic pulmonary fibrosis

Background Lung transplantation is the optimal treatment choice, while extracorporeal membrane oxygenation (ECMO) provides cardiopulmonary support during the perioperative period of lung transplantation. Currently, there is no reported research on the ECMO withdrawal and duration of mechanical ventilation in idiopathic pulmonary fibrosis (IPF) patients undergoing lung transplantation. Therefore, this study aims to evaluate the impact of ECMO duration on prolonged mechanical ventilation (MV) time in patients, attempting to explore the relationship between the two. Methods This study included 170 patients with IPF who underwent lung transplantation under ECMO technology. The patients were divided into normal and delayed groups based on the ECMO application time of 72 hours. A multifactor logistic regression analysis was conducted to explore the independent risk factors for prolonged mechanical ventilation time (more than 3 days), and restricted cubic spline was used to investigate the relationship between ECMO application time and MV time. Receiver operating characteristic (ROC) was further utilized to assess the performance of ECMO application time in predicting prolonged mechanical ventilation time for patients. Results The gender and ECMO application time of patients with IPF are independent risk factors for prolonged MV time. In post-lung transplant patients, for each additional hour of ECMO application time, the risk of MV exceeding 3 days increases by 0.15 times. A restrictive cubic spline plot of ECMO application time and MV time shows a nonlinear relationship between the two groups, with an area under the ROC curve of 0.854 (95% CI 0.796–0.913, P < 0.05). Conclusion After lung transplantation, there is a nonlinear relationship between the application time of ECMO and MV time in patients with IPF. The application time of ECMO can predict well the extension of MV in patients during ICU stay. Therefore, clinicians can assess the duration of MV in patients with IPF based on the application time of ECMO, further avoiding complications related to MV.