Original articleGeneral thoracicAwake Extracorporeal Membrane Oxygenation as Bridge to Lung Transplantation: A 9-Year Experience
Section snippets
Patients
Data were retrospectively collected from medical charts for all patients who received ECMO as a BTT at New York-Presbyterian Hospital/Columbia University Medical Center from January 1, 2007 through July 10, 2016. Patients were identified as having a BTT if they were already on our institution’s lung transplant list before ECMO initiation. No patients underwent ECMO as a “bridge to decision.” Data collected included demographic information, preoperative data, operative variables, complications,
Results
Between January 1, 2007 and July 10, 2016, 72 patients underwent ECMO with the goal of a BTT. The cause of respiratory failure was CF in 27 (37.5%) patients, ILD in 30 (41.7%), and other conditions in the remaining 15 (20.8%), as detailed in Table 1.
The average Simplified Acute Physiology Score II, which is a measure of disease severity for patients admitted to an intensive care unit, was 28.5 ± 12.0, and the average lung allocation score at the time of ECMO placement was 91.2 ± 5.9. Fifty
Comment
Our experience of 72 patients managed with ECMO intended as a BTT is a large, single-center series. During our 9-year experience, our approach to patient selection, timing of ECMO initiation, and configuration choice has evolved and is outlined in our algorithm (Fig 1), with the goal of allocating ECMO in the most effective way to the patients who have the most reasonable chances of undergoing lung transplantation. Our posttransplant 1-year survival rate was 90.3%, which compares favorably with
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Drs Brodie and Bacchetta are co-senior authors.