• Johannes Hadem, Olaf Wiesner, Tobias Welte, Marius M Hoeper, Wiebke Sommer, Gregor Warnecke, Mark Greer, Axel Haverich, Jens Gottlieb, Thomas Fuehner, Christian Kuehn, Igor Tudorache, and Karen M Olsson.
• Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
• Am. J. Respir. Crit. Care Med.. 2012 Apr 1;185(7):763-8.

RationaleThe use of extracorporeal membrane oxygenation (ECMO) in patients who are awake and spontaneously breathing may represent a novel bridging strategy toward lung transplantation (LuTx).ObjectivesTo evaluate the outcomes of patients treated with the "awake ECMO" concept as bridge to transplantation.MethodsWe 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 ResultsTwenty-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).ConclusionsECMO 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.

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