title: Outcome of Extracorporeal Membrane Oxygenation as a Bridge To Lung Transplantation: An Institutional Experience and Literature Review.
abstract: BACKGROUND
  Extracorporeal life support (ECLS) as a bridge to lung transplantation (LuTx) is a promising option for patients with end-stage lung disease on the transplant waiting list. We investigated the outcome of patients bridged to lung transplantation on ECLS technologies, mainly extracorporeal membrane oxygenation (ECMO).
  
  
  METHODS
  Between January 2007 and October 2013, ECLS was implanted in 30 patients with intention to bridge to LuTx. Twenty-six patients (26/30) were successfully bridged to LuTx on ECLS. The most common diagnosis was cystic fibrosis (N = 12). Venovenous ECMO was used in 10, venoarterial in 4, interventional lung assist in 5, and stepwise combination of them in 7 recipients.
  
  
  RESULTS
  Two patients weaned from ECMO, and 2 patients died on ECMO on the waiting list. Median duration of ECLS was 21 days (1-81 years). Six patients were awake and spontaneously breathing during ECLS support. Thirty-day, 1-year, and 2-year survivals were 89%, 68%, and 53%, respectively, for bridged patients and 96%, 85%, and 79%, respectively, for control group (P = 0.001). Three months conditional survivals were 89% and 69% at 1 and 2 years for ECLS group, compared to 92% and 86% for control group (P = 0.03). Cystic fibrosis recipients had 82% survival rate at 1 and 2 years. All recipients bridged to LuTx on awake ECLS (N = 6) are alive with a median follow-up of 10.8 months (range, 6-21 months).
  
  
  CONCLUSIONS
  Our data show significantly lower survival in this high-risk group compared to patients transplanted without preoperative ECLS. Awake and ambulatory ECLS provides the best prognosis for these high-risk patients.
authors: 1 Department of Thoracic Surgery University Hospital, Zurich University Hospital, Zurich, Switzerland. 2 Division of Medical Intensive Care Unit, University Hospital, Zurich, Switzerland. 3 Division of Surgical Intensive Care Unit, University Hospital, Zurich, Switzerland. 4 Division of Pulmonary Medicine, University Hospital, Zurich, Switzerland.
authors: Ilhan
authors: I
authors: Inci
authors: Stephanie
authors: S
authors: Klinzing
authors: Didier
authors: D
authors: Schneiter
authors: Reto A
authors: RA
authors: Schuepbach
authors: Peter
authors: P
authors: Kestenholz
authors: Sven
authors: S
authors: Hillinger
authors: Christian
authors: C
authors: Benden
authors: Marco
authors: M
authors: Maggiorini
authors: Walter
authors: W
authors: Weder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D008171:Lung Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists / Q000401:mortality; D014851:Wakefulness; D055815:Young Adult