title: Extracorporeal membrane oxygenation as a bridge to lung transplantation in the United States: an evolving strategy in the management of rapidly advancing pulmonary disease.
abstract: OBJECTIVE
  Improvements in technology have led to a resurgence in the use of extracorporeal membrane oxygenation as a bridge to lung transplantation. By using a national registry, we sought to evaluate how short-term survival has evolved using this strategy.
  
  
  METHODS
  With the use of the United Network for Organ Sharing database, we analyzed data from 12,458 adults who underwent lung transplantation between 2000 and 2011. Patients were categorized into 2 cohorts: 119 patients who were bridged to transplantation using extracorporeal membrane oxygenation and 12,339 patients who were not. The study period was divided into four 3-year intervals: 2000 to 2002, 2003 to 2005, 2006 to 2008, and 2009 to 2011. With Kaplan-Meier analysis, 1-year survival was compared for the 2 cohorts of patients in each of the time periods. A propensity score-adjusted Cox regression model was used to estimate the risk of 1-year mortality.
  
  
  RESULTS
  Of the total number of recipients, 4 (3.4%) were bridged between 2000 and 2002, 17 (14.3%) were bridged between 2003 and 2005, 31 (26.1%) were bridged between 2006 and 2008, and 67 were bridged (56.3%) between 2009 and 2011. Recipients bridged using extracorporeal membrane oxygenation were more likely to be younger and diabetic and to have higher serum creatinine and bilirubin levels. The 1-year survival for those bridged with extracorporeal membrane oxygenation was significantly lower in subsequent periods: 25.0% versus 81.0% (2000-2002), 47.1% versus 84.2% (2006-2008), and 74.4% versus 85.7% (2009-2011). However, this survival progressively increased with each period, as did the number of patients bridged using extracorporeal membrane oxygenation.
  
  
  CONCLUSIONS
  Short-term survival with the use of extracorporeal membrane oxygenation as a bridge to lung transplantation has significantly improved over the past few years.
authors.affiliation: DeVos Heart and Lung Transplantation Program Spectrum Health, Michigan State University, Grand Rapids, Mich.
authors.forename: Awori J
authors.initials: AJ
authors.lastname: Hayanga
authors.affiliation: Johns Hopkins School of Public Health, Baltimore, Md.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Aboagye
authors.affiliation: Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Stephen
authors.initials: S
authors.lastname: Esper
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Norihisa
authors.initials: N
authors.lastname: Shigemura
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Bermudez
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Jonathan
authors.initials: J
authors.lastname: D'Cunha
authors.affiliation: Heart and Vascular Center, Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa. Electronic address: jay-bhama@uiowa.edu.
authors.forename: Jay K
authors.initials: JK
authors.lastname: Bhama
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality / Q000639:trends; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008171:Lung Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists / Q000401:mortality