title: Extracorporeal membrane oxygenation with spontaneous breathing as a bridge to lung transplantation.
abstract: OBJECTIVE
  A large number of transplantation centres consider extracorporeal membrane oxygenation as an inappropriate option for bridging critical patients to lung transplantation. Technical improvements such as the introduction of a polymethylpentene membrane, new centrifugal pumps and heparin-coated circuits have led to a safer application of extracorporeal membrane oxygenation, and an increasing number of centres are reporting their positive experiences. The aim of this study was to review our practice in bridging critical candidates to lung transplantation with extracorporeal membrane oxygenation, by comparing patients with invasive mechanical ventilation with patients with spontaneous breathing.
  
  
  METHODS
  The records of candidates for lung transplantation treated with extracorporeal membrane oxygenation have been revised.
  
  
  RESULTS
  From February 2008 to 2012, 11 patients who experienced an abrupt worsening of their respiratory conditions were treated with extracorporeal membrane oxygenation; mean age: 33.9 ± 13.2 years, male/female ratio: 5/6, 6 patients were affected by cystic fibrosis, 2 had chronic rejection after transplantation, 2 had pulmonary fibrosis and 1 had systemic sclerosis. Seven patients were awake, while 4 patients received invasive mechanical ventilation. The sequential organ failure assessment score significantly increased during bridging time and this increase was significantly higher in the intubated patients. All the patients had bilateral lung transplantation. Spontaneously breathing patients showed a tendency to require a shorter duration of invasive mechanical ventilation, intensive care unit stay and hospital stay after transplantation. One-year survival rate was 85.7% in patients with spontaneous breathing vs 50% in patients with invasive mechanical ventilation.
  
  
  CONCLUSIONS
  Extracorporeal membrane oxygenation in spontaneously breathing patients is a feasible, effective and safe bridge to lung transplantation.
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Nosotti
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Rosso
authors.forename: Davide
authors.initials: D
authors.lastname: Tosi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Palleschi
authors.forename: Paolo
authors.initials: P
authors.lastname: Mendogni
authors.forename: Ilaria Faustina
authors.initials: IF
authors.lastname: Nataloni
authors.forename: Stefania
authors.initials: S
authors.lastname: Crotti
authors.forename: Paolo
authors.initials: P
authors.lastname: Tarsia
mesh_terms: D000328:Adult; D016638:Critical Illness; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008171:Lung Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016040:Lung Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D012119:Respiration; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult