We have looked into this issue before, with several succesful case reports and case series being reported. Fuehner et al who has previously released case series, have now compared 26 awake ECMO bridgings to lung transplant (LTx) to historical controls with mechanical ventilation. ECMO comes out in front.
Higher survival, better survival.
The ECMO group seemed to be in better shape, as they needed less time on a ventilator after LTx and had shorter post operative stays. The main finding was that survival after 6 months was 80% in the ECMO group and 50% in the traditional mechanically ventilated group. This could be due to the ECMO group being awake and able to move, eat, receive physiotherapy and generally be in better shape to endure the LTx and the recouperation.
ECMO as standard of care?
ECMO has traditionally been used as a rescue intervention in patients refractory to standard therapy. For the pro-ECMO people, this has been listed as a cause for the bad outcomes of early ECMO trials, combined with the complexity and need for intense anticoagulation of the old ECMO systems. In the newer, easier to use ECMOs, it seems more important to get patients on ECMO before they crash, not as a rescue attempt after they’ve already burned half their organ systems. So this article had a rather new way of doing things, putting patients on ECMO as the first choice when they became to sick to support their own ventilation. There’s a good editorial on the article in Am J Respir Crit Care Med: “Extracorporeal membrane oxygenation as bridge to lung transplantation: what remains in order to make it standard of care?” commenting on ECMO as the possible near future as standard of care for LTx and other patient groups.