Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation

Am J Respir Crit Care Med. 2012 Apr 1;185(7):763-8. doi: 10.1164/rccm.201109-1599OC. Epub 2012 Jan 20.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Extracorporeal Membrane Oxygenation* / adverse effects
  • Extracorporeal Membrane Oxygenation* / methods
  • Female
  • Humans
  • Lung Diseases / surgery
  • Lung Diseases / therapy
  • Lung Transplantation / methods*
  • Male
  • Middle Aged
  • Respiration, Artificial
  • Retrospective Studies
  • Treatment Outcome
  • Waiting Lists
  • Young Adult