title: Outcome of extracorporeal membrane oxygenation as a bridge to lung transplantation and graft recovery.
abstract: BACKGROUND
  Indications for extracorporeal membrane oxygenation (ECMO) use in lung transplantation are (1) temporary assistance as a bridge to transplantation, (2) stabilization of hemodynamics during transplantation in place of cardiopulmonary bypass, and (3) treatment of severe lung dysfunction and primary graft failure after transplantation. This study compares the survival of lung transplant recipients requiring ECMO support with survival of patients without ECMO.
  
  
  METHODS
  A retrospective database review was performed for 108 consecutive patients who underwent single-lung or bilateral-lung transplantation at our center between 2002 and 2009.
  
  
  RESULTS
  Of 108 transplant recipients, 27 (25%) required venoarterial ECMO compared with 81 patients who did not. Nine patients required ECMO preoperatively (87±102 hours), and ECMO was continued for 5 patients during the lung transplant operation. Seven additional patients received ECMO during transplantation. Six patients required early (<7 days) and 5 patients delayed (≥7 days) postoperative ECMO for treatment of allograft dysfunction. The subgroup with support showed the most favorable patient discharge rate (66.7%). ECMO support was a significant risk factor for death (p<0.001). Survival was significantly reduced with the use of ECMO: 30-day, 90-day, 1-year, and 5-year survival was 97%, 91%, 83%, and 58% in the patients without ECMO compared with 63%, 44%, 33%, and 21% in those with ECMO, respectively.
  
  
  CONCLUSIONS
  Survival after lung transplantation was significantly reduced with ECMO. However, patients who survived the first year showed similar long-term survival as those patients who did not need perioperative ECMO support.
authors: Heart Center of the University of Leipzig, Leipzig, Germany. hartmuth.bittner@medizin.uni-leipzig.de
authors: Hartmuth B
authors: HB
authors: Bittner
authors: Sven
authors: S
authors: Lehmann
authors: Ardawan
authors: A
authors: Rastan
authors: Jens
authors: J
authors: Garbade
authors: Christian
authors: C
authors: Binner
authors: Friedrich W
authors: FW
authors: Mohr
authors: Markus J
authors: MJ
authors: Barten
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016208:Databases, Factual; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D016040:Lung Transplantation / Q000379:methods* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D055031:Primary Graft Dysfunction / Q000401:mortality / Q000628:therapy*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014850:Waiting Lists