Institution of extracorporeal membrane oxygenation late after lung transplantation – a futile exercise? With the development of more reliable extracor- poreal membrane oxygenator (ECMO) circuitry over the last decade, the use of and indications for this type of support is expanding (1). However, published data on the use of ECMO support in the postoperative setting of lung transplantation are limited with widely varying results (2–5). Since the inception of our lung transplant program in 1990, we have performed over 850 lung transplants and 24 of these patients have required postoperative support with ECMO. The indications for institu- tion of ECMO have fallen into two broad catego- ries: primary graft dysfunction (PGD), and other causes of allograft failure such as infection and rejection. Our impression has been that the later institution of ECMO for causes other than primary graft failure is futile. Although we have tried to salvage these patients with a period of support with ECMO, the resource utilization is very high and our results have been poor. We therefore decided to critically analyze these patients to guide our future decision making in these types of patients. Methods Since the inception of our lung transplant program in 1990 to the end of 2008, we performed 665 lung transplants. Of these, 373 have been bilateral sequential, 230 have been single, and 62 heart– lung transplants have been performed. Twenty- four lung transplant recipients have required ECMO support postoperatively. In 13 patients, ECMO was instituted within the first 48 h (‘‘early’’ Marasco SF, Vale M, Preovolos A, Pellegrino V, Lee G, Snell G, Williams T. Institution of extracorporeal membrane oxygenation late after lung transplantation – a futile exercise? Clin Transplant 2012: 26: E71–E77. ª 2011 John Wiley & Sons A/S. Abstract: The use of and indications for extracorporeal membrane oxy- genation (ECMO) are expanding as its reliability improves with widely varying results reported. A retrospective review of 24 lung transplant recipients who required ECMO support postoperatively was performed with 13 patients requiring ECMO within the first 48 h (‘‘early’’ group) and 11 requiring ECMO after seven d postoperatively (‘‘late’’ group). The majority of early ECMO group had primary graft failure patients and the late ECMO group comprised patients with infection or non-specific graft failure. There were significant differences in outcomes between groups, with 10/13 in the early group and 4/11 in the late group successfully weaned from ECMO (p = 0.045). Six of the 13 patients in the early group and none of the late group survived to hospital discharge (p = 0.009). The late ECMO group had a much higher incidence of death owing to complications existing prior to institution of ECMO (essentially uncontrolled infection or organ failure). There were no differences in complications arising during ECMO between groups. Late institution of ECMO in lung transplant recipients for causes other than primary graft failure is associated with such poor survival that its use should be considered only in very select cases. Silvana F. Marasco a,b , Matthew Vale a , Arthur Preovolos c , Vince Pellegrino d , Geraldine Lee a , Greg Snell e and Trevor Williams e a Cardiothoracic Surgery Unit, The Alfred Hospital, b Department of Surgery, Monash University, c Department of Perfusion, The Alfred Hospital, d Intensive Care Unit, The Alfred Hospital, e Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Vic., Australia Key words: complications – extracorporeal membrane oxygenation – lung transplant Corresponding author: Dr. Silvana Marasco, MBBS (Hons), MS, FRACS, Cardiothoracic Sur- geon, The Alfred Hospital, Commercial Road, Prahran, Vic. 3181, Australia. Tel.: +61 3 9076 2558; fax: +61 3 9076 2317; e-mail: s.marasco@alfred.org.au Conflict of interest: The authors have no conflict of interest to declare. Accepted for publication 24 August 2011 Clin Transplant 2012: 26: E71–E77 DOI: 10.1111/j.1399-0012.2011.01562.x ª 2011 John Wiley & Sons A/S. E71