title: Extracorporeal membrane oxygenation as a bridge to lung transplant: midterm outcomes.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) is used occasionally as a bridge to lung transplantation. The impact on mid-term survival is unknown. We analyzed outcomes after lung transplant over a 19-year period in patients who received ECMO support.
  
  
  METHODS
  From March 1991 to October 2010, 1,305 lung transplants were performed at our institution. Seventeen patients (1.3%) were supported with ECMO before lung transplant. Diagnoses included retransplantation (n = 6), pulmonary fibrosis (n = 6), cystic fibrosis (n = 4), and chronic obstructive pulmonary disease (n = 1). Fifteen patients underwent double lung transplant, one patient had single left lung transplant and one patient had a heart-lung transplant. Venovenous and venoarterial ECMO were implanted in eight and nine cases, respectively. Median duration of support was 3.2 days (range, 1 to 49 days). Mean patient follow-up was 2.3 years.
  
  
  RESULTS
  Thirty-day, 1-year, and 3-year survivals were 81%, 74%, and 65%, respectively, for the supported patients and 93%, 78%, and 62% in the control group (p = 0.56). Two-year survival was not affected by ECMO type, with survival of five out of nine patients supported by venoarterial ECMO vs seven out of eight patients supported by venovenous ECMO (p = 0.17). At 1- year follow-up, allograft function for the ECMO-supported patients did not differ from the control group (forced expiratory volume in one second, 2.35 L vs 2.09 L, p = 0.39) (forced vital capacity, 3.06 L vs 2.71 L, p = 0.34).
  
  
  CONCLUSIONS
  Extracorporeal membrane oxygenation as a bridge to lung transplantation is associated with higher perioperative mortality but acceptable mid-term survival in carefully selected patients. Late allograft function did not differ in patients who received ECMO support before lung transplant from those who did not receive ECMO.
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. bermudezc@upmc.edu
authors.forename: Christian A
authors.initials: CA
authors.lastname: Bermudez
authors.forename: Rodolfo V
authors.initials: RV
authors.lastname: Rocha
authors.forename: Diana
authors.initials: D
authors.lastname: Zaldonis
authors.forename: Jay K
authors.initials: JK
authors.lastname: Bhama
authors.forename: Maria M
authors.initials: MM
authors.lastname: Crespo
authors.forename: Norihisa
authors.initials: N
authors.lastname: Shigemura
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Pilewski
authors.forename: Penny L
authors.initials: PL
authors.lastname: Sappington
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Boujoukos
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005500:Follow-Up Studies; D006085:Graft Survival; D016041:Heart-Lung Transplantation / Q000379:methods / Q000401:mortality; D006801:Humans; D016040:Lung Transplantation / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011300:Preoperative Care / Q000379:methods*; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome