Building Bridges: Extracorporeal Membrane Oxygenation Versus Mechanical Ventilation as Bridge to Lung Transplant—A Nationwide Analysis

In this nationwide United Network for Organ Sharing (UNOS) analysis (2005–2025), Potel et al. compared extracorporeal membrane oxygenation (ECMO), pretransplant mechanical ventilation (pMV), and combined ECMO plus pMV as bridges to lung transplantation. Among 40,305 adult recipients, 925 were bridged with ECMO, 1,144 with pMV, and 1,063 with both. ECMO plus pMV patients had more post-transplant dialysis and longer hospital stays, while pMV-only patients had the highest one-year rejection rates; however, unadjusted and multivariable-adjusted survival at one and five years did not differ across the three strategies. For CTSNet’s global audience, this study supports the view that, in experienced centers, both ECMO and mechanical ventilation (alone or combined) can provide comparable medium-term outcomes, allowing flexible, center-specific bridging strategies tailored to patient physiology and institutional resources without compromising post-transplant survival.