title: Awake Extracorporeal Membrane Oxygenation as Bridge to Lung Transplantation: A 9-Year Experience.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) is used as a bridge to lung transplantation, but characteristics that influence its success are poorly understood. This large, single-center experience evaluated the implementation and outcomes of ECMO in this setting.
  
  
  METHODS
  Data were collected for patients at our institution (New York-Presbyterian Hospital/Columbia University Medical Center in New York) who received ECMO as a bridge to lung transplantation from January 1, 2007 through July 10, 2016. Data were analyzed for demographics, baseline characteristics, survival, and ECMO configuration.
  
  
  RESULTS
  Seventy-two patients received ECMO as a bridge to lung transplantation. Of the 72 patients, 40 (55.6%) underwent the transplantation procedure, 37 (92.5%) survived to discharge, and 21 (84.0%) survived for 2 years. Inotropy or vasopressor support (70% vs 93.8%; p = 0.011), Simplified Acute Physiology Score (26.8 vs 30.5; p = 0.048), and ambulation (80% vs 56.2%; p = 0.030) were significantly different between the patients who underwent lung transplantation and those who did not. Patients with cystic fibrosis were more likely to have a bridge to transplantation than patients with other lung diseases (47.5% vs 25%; p = 0.050). Daily participation in physical therapy was achieved in 50 patients (69.4%).
  
  
  CONCLUSIONS
  This study demonstrated favorable survival in patients receiving ECMO as a bridge to lung transplantation and achieved high rates of physical therapy and avoidance of mechanical ventilation while ECMO was used in patients awaiting lung transplantation. With more than half of these patients successfully bridged to lung transplantation, we gained insight into the factors influencing patients' outcomes, including patient selection, timing of ECMO, and patient management.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Mauer
authors.initials: M
authors.lastname: Biscotti
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York.
authors.forename: Whitney D
authors.initials: WD
authors.lastname: Gannon
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York.
authors.forename: Cara
authors.initials: C
authors.lastname: Agerstrand
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York.
authors.forename: Darryl
authors.initials: D
authors.lastname: Abrams
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Joshua
authors.initials: J
authors.lastname: Sonett
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York.
authors.forename: Daniel
authors.initials: D
authors.lastname: Brodie
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York. Electronic address: mb781@cumc.columbia.edu.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bacchetta
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D012131:Respiratory Insufficiency / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists