title: Organ allocation waiting time during extracorporeal bridge to lung transplant affects outcomes.
abstract: BACKGROUND
  The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplant (LTX) is still being debated.
  
  
  METHODS
  We performed a retrospective two-center analysis of the relationship between ECMO bridging duration and survival in 25 patients. Further survival analysis was obtained by dividing the patients according to waiting time on ECMO: up to 14 days (Early group) or longer (Late group). We also analyzed the impact of the ventilation strategy during ECMO bridging (ie, spontaneous breathing and noninvasive ventilation [NIV] or intubation and invasive mechanical ventilation [IMV]).
  
  
  RESULTS
  Seventeen of 25 patients underwent a transplant (with a 76% 1-year survival), whereas eight patients died during bridging. In the 17 patients who underwent a transplant, mortality was positively related to waiting days until LTX (hazard ratio [HR], 1.12 per day; 95% CI, 1.02-1.23; P = .02), and the Early group showed better Kaplan-Meier curves (P = .02), higher 1-year survival rates (100% vs 50%, P = .03), and lower morbidity (days on IMV and length of stay in ICU and hospital). During the bridge to transplant, mortality increased steadily with time. Considering the overall outcome of the bridging program (25 patients), bridge duration adversely affected survival (HR, 1.06 per day; 95% CI, 1.01-1.11; P = .015) and 1-year survival (Early, 82% vs Late, 29%; P = .015). Morbidity indexes were lower in patients treated with NIV during the bridge.
  
  
  CONCLUSIONS
  The duration of the ECMO bridge is a relevant cofactor in the mortality and morbidity of critically ill patients awaiting organ allocation. The NIV strategy was associated with a less complicated clinical course after LTX.
authors.affiliation: Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico of Milan, Milan. Electronic address: stefania.crotti@policlinico.mi.it.
authors.forename: Stefania
authors.initials: S
authors.lastname: Crotti
authors.affiliation: Anestesia e Rianimazione 2, Fondazione IRCCS Policlinico S. Matteo, Pavia.
authors.forename: Giorgio A
authors.initials: GA
authors.lastname: Iotti
authors.affiliation: Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico of Milan, Milan.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Lissoni
authors.affiliation: Anestesia e Rianimazione 2, Fondazione IRCCS Policlinico S. Matteo, Pavia.
authors.forename: Mirko
authors.initials: M
authors.lastname: Belliato
authors.affiliation: Anestesia e Rianimazione 1, Fondazione IRCCS Policlinico S. Matteo, Pavia.
authors.forename: Marinella
authors.initials: M
authors.lastname: Zanierato
authors.affiliation: Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico of Milan, Milan.
authors.forename: Monica
authors.initials: M
authors.lastname: Chierichetti
authors.affiliation: Anestesia e Rianimazione 2, Fondazione IRCCS Policlinico S. Matteo, Pavia.
authors.forename: Guendalina
authors.initials: G
authors.lastname: Di Meo
authors.affiliation: Pneumologia, Fondazione IRCCS Policlinico S. Matteo, Pavia; Dipartimento di Medicina Molecolare, Università degli Studi, Pavia, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Meloni
authors.affiliation: Respiratory Medicine Section, Dipartimento Toraco-Polmonare e Cardiocircolatorio, Università degli Studi, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico of Milan.
authors.forename: Marilena
authors.initials: M
authors.lastname: Pappalettera
authors.affiliation: Operative Unit for Thoracic Surgery and Lung Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico of Milan, Milan.
authors.forename: Mario
authors.initials: M
authors.lastname: Nosotti
authors.affiliation: Operative Unit for Thoracic Surgery and Lung Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico of Milan, Milan.
authors.forename: Luigi
authors.initials: L
authors.lastname: Santambrogio
authors.affiliation: Cardiochirurgia, Fondazione IRCCS Policlinico S. Matteo, Pavia.
authors.forename: Mario
authors.initials: M
authors.lastname: Viganò
authors.affiliation: Anestesia e Rianimazione 1, Fondazione IRCCS Policlinico S. Matteo, Pavia.
authors.forename: Antonio
authors.initials: A
authors.lastname: Braschi
authors.affiliation: Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Università degli Studi, Milan; Dipartimento di Scienze Clinico-chirurgiche, Diagnostiche e Pediatriche, Università degli Studi, Pavia, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Gattinoni
mesh_terms: D000328:Adult; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult