Perioperative management of bridge-to-lung transplant using ECMO

Respiratory failure requiring intubation has traditionally been a relative contraindication to lung transplantation due to increased morbidity and mortality. Advances in extracorporeal membranous oxygenation (ECMO) have made it possible to extubate patients and provide physical therapy with minimal native lung function. By "bridging" patients to lung transplant using ECMO, they are able to undergo rehabilitation and withstand the demands of surgery. However, providing anesthesia for these cases requires an understanding of ECMO physiology and the pharmacology associated with ECMO. We describe the anesthetic for four patients who were bridged to lung transplant and the complexities of their perioperative management.