RATIONALE: The use of extracorporeal membrane oxygenation (ECMO) in patients who are awake and spontaneously breathing may represent a novel bridging strategy toward lung transplantation (LuTx). OBJECTIVES: To evaluate the outcomes of patients treated with the "awake ECMO" concept as bridge to transplantation. METHODS: We performed a retrospective, single-center, intention-to-treat analysis of consecutive LuTx candidates with terminal respiratory or cardiopulmonary failure receiving awake ECMO support. The outcomes were compared with a historical control group of patients treated with conventional mechanical ventilation (MV group) as bridge to transplant. MEASUREMENTS AND MAIN RESULTS: Twenty-six patients (58% female; median age, 44 yr; range, 23-62) were included in the awake ECMO group and 34 patients (59% female; median age, 36 yr; range, 18-59) in the MV group. The duration of ECMO support or MV, respectively, was comparable in both groups (awake ECMO: median, 9 d; range, 1-45. MV: median, 15 d; range, 1-71; P = 0.25). Six (23%) of 26 patients in the awake ECMO group and 10 (29%) of 34 patients in the MV group died before a donor organ was available (P = 0.20). Survival at 6 months after LuTx was 80% in the awake ECMO group versus 50% in the MV group (P = 0.02). Patients in the awake ECMO group required shorter postoperative MV (P = 0.04) and showed a trend toward a shorter postoperative hospital stay (P = 0.06). CONCLUSIONS: ECMO support in patients who are awake and nonintubated represents a promising bridging strategy, which should be further evaluated to determine its role in patients with end-stage lung disease awaiting LuTx.
RATIONALE: The use of extracorporeal membrane oxygenation (ECMO) in patients who are awake and spontaneously breathing may represent a novel bridging strategy toward lung transplantation (LuTx). OBJECTIVES: To evaluate the outcomes of patients treated with the "awake ECMO" concept as bridge to transplantation. METHODS: We performed a retrospective, single-center, intention-to-treat analysis of consecutive LuTx candidates with terminal respiratory or cardiopulmonary failure receiving awake ECMO support. The outcomes were compared with a historical control group of patients treated with conventional mechanical ventilation (MV group) as bridge to transplant. MEASUREMENTS AND MAIN RESULTS: Twenty-six patients (58% female; median age, 44 yr; range, 23-62) were included in the awake ECMO group and 34 patients (59% female; median age, 36 yr; range, 18-59) in the MV group. The duration of ECMO support or MV, respectively, was comparable in both groups (awake ECMO: median, 9 d; range, 1-45. MV: median, 15 d; range, 1-71; P = 0.25). Six (23%) of 26 patients in the awake ECMO group and 10 (29%) of 34 patients in the MV group died before a donor organ was available (P = 0.20). Survival at 6 months after LuTx was 80% in the awake ECMO group versus 50% in the MV group (P = 0.02). Patients in the awake ECMO group required shorter postoperative MV (P = 0.04) and showed a trend toward a shorter postoperative hospital stay (P = 0.06). CONCLUSIONS: ECMO support in patients who are awake and nonintubated represents a promising bridging strategy, which should be further evaluated to determine its role in patients with end-stage lung disease awaiting LuTx.
Authors: Sophia F Tam; Anahita Mobargha; Joseph Tobias; Christine A Schad; Shunpei Okochi; William Middlesworth; Vincent Duron Journal: Int Wound J Date: 2018-12-02 Impact factor: 3.315
Authors: Jeremiah William Awori Hayanga; Heather K Hayanga; James H Fugett; Kelsey A Musgrove; Ghulam Abbas; Christopher R Ensor; Vinay Badhwar; Norihisa Shigemura Journal: Transpl Int Date: 2020-05-12 Impact factor: 3.782
Authors: Jeffrey DellaVolpe; Ryan P Barbaro; Jeremy W Cannon; Eddy Fan; Wendy R Greene; Kyle J Gunnerson; Lena M Napolitano; Ace Ovil; Jeremy C Pamplin; Matthieu Schmidt; Lauren R Sorce; Daniel Brodie Journal: Crit Care Med Date: 2020-06 Impact factor: 7.598