title: Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation.
abstract: BACKGROUND
  The use of extracorporeal membrane oxygenation (ECMO) in patients who are awake and spontaneously breathing may represent a novel bridging strategy toward lung transplantation (LuTx).
  
  
  OBJECTIVE
  To evaluate the outcomes of patients treated with the "awake ECMO" concept as bridge to transplantation.
  
  
  METHODS
  We performed a retrospective, single-center, intention-to-treat analysis of consecutive LuTx candidates with terminal respiratory or cardiopulmonary failure receiving awake ECMO support. The outcomes were compared with a historical control group of patients treated with conventional mechanical ventilation (MV group) as bridge to transplant.
  
  
  RESULTS
  Twenty-six patients (58% female; median age, 44 yr; range, 23-62) were included in the awake ECMO group and 34 patients (59% female; median age, 36 yr; range, 18-59) in the MV group. The duration of ECMO support or MV, respectively, was comparable in both groups (awake ECMO: median, 9 d; range, 1-45. MV: median, 15 d; range, 1-71; P = 0.25). Six (23%) of 26 patients in the awake ECMO group and 10 (29%) of 34 patients in the MV group died before a donor organ was available (P = 0.20). Survival at 6 months after LuTx was 80% in the awake ECMO group versus 50% in the MV group (P = 0.02). Patients in the awake ECMO group required shorter postoperative MV (P = 0.04) and showed a trend toward a shorter postoperative hospital stay (P = 0.06).
  
  
  CONCLUSIONS
  ECMO support in patients who are awake and nonintubated represents a promising bridging strategy, which should be further evaluated to determine its role in patients with end-stage lung disease awaiting LuTx.
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fuehner
authors.forename: Christian
authors.initials: C
authors.lastname: Kuehn
authors.forename: Johannes
authors.initials: J
authors.lastname: Hadem
authors.forename: Olaf
authors.initials: O
authors.lastname: Wiesner
authors.forename: Jens
authors.initials: J
authors.lastname: Gottlieb
authors.forename: Igor
authors.initials: I
authors.lastname: Tudorache
authors.forename: Karen M
authors.initials: KM
authors.lastname: Olsson
authors.forename: Mark
authors.initials: M
authors.lastname: Greer
authors.forename: Wiebke
authors.initials: W
authors.lastname: Sommer
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Marius M
authors.initials: MM
authors.lastname: Hoeper
authors.forename: Gregor
authors.initials: G
authors.lastname: Warnecke
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000601:surgery / Q000628:therapy; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult