Review
Extracorporeal membrane oxygenation in lung transplantation
Oxigenador de membrana extracorpóreo en el trasplante pulmonar
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Vicente, I. Moreno, A. Soria, F. Ramos, S. Torregrosa" "autores" => array:5 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Vicente" "email" => array:1 [ 0 => "ro.vicenteg@comv.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Soria" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "F." 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"apellidos" => "Torregrosa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Anestesiología-Reanimación, Hospital Universitario La Fe, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Cardíaca, Hospital Universitario La Fe, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Oxigenador de membrana extracorpóreo en el trasplante pulmonar" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Lung transplantation (LT) is a management option in non-malignant end-stage pulmonary disease including alterations of the airway, lung parenchyma and pulmonary circulation. The number of LT procedures is gradually increasing both in Spain and in other countries.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, difficulties and complications are found that require the adoption of special measures in order to achieve better perioperative results. In this context, the number of patients on the transplant waiting list is growing due to a lack of organs; as a result, mortality among patients on the waiting list is significant–hence the concern about increasing the number of potential donations by means of different methods.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> Based on the data offered by the international LT registry, the mortality rate among patients on the waiting list is 20% during the first year and 40% beyond the second year. Another important aspect to be taken into account is the fact that about 10% of all LTs performed each year are carried out on an emergency basis–some patients requiring pretransplant mechanical ventilation that gives rise to different problems such as barotrauma, volutrauma, a high risk of infection and myopathy, which in turn increase morbidity and mortality.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a> Furthermore, despite the great advances made in perioperative patient management, primary graft dysfunction and cardiovascular alterations continue to represent the main causes of mortality in the immediate postoperative period.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Artificial devices offer pulmonary and circulatory support that contributes to lessen morbidity–mortality among selected patients during the different phases of the perioperative period. The present study offers a review of the literature on the utilization of extracorporeal membrane oxygenation (ECMO) devices in the perioperative period of patients subjected to LT.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The use of extracorporeal technologies in cardiopulmonary support has increased over the last 20 years. ECMO devices are the most widely used option and have been used for years in LT programs. However, few large series offering results referred to the use of ECMO in these patients have been published to date. Indeed, even the Extracorporeal Life Support Organization (ELSO) presents a limited series, since it only reports 151 cases with a patient survival rate of 42%.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">ECMO makes use of a pump and an oxygenator to provide prolonged hemodynamic and/or respiratory support–its indications being cardiogenic shock and severe respiratory failure refractory to optimum conventional treatment.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Depending on the intended purpose, we can choose venovenous ECMO (ECMO VV) for respiratory failure and/or venoarterial ECMO (ECMO VA) when moreover there is also hemodynamic impairment. These systems can be used for variable periods of time ranging from days to weeks, though some studies have already reported the results of even longer periods of use.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> The criteria employed by our group for using ECMO as respiratory and/or hemodynamic support in patients who fail to respond to usual treatment are specified in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">In addition to providing immediate oxygen support in severely hypoxemic and/or acidotic patients, ECMO in respiratory failure affords lung protection, since it allows the use of less damaging mechanical ventilation strategies based on the reduction of airway pressures and the concentration of supplied oxygen. ECMO devices should by applied on an early basis in order to avoid serious worsening of the clinical condition of the patient and to secure greater chances for reverting the lung and multiorgan damage.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The Minnesota group has published its experience with patients presenting early graft dysfunction, introducing ECMO in the first 24<span class="elsevierStyleHsp" style=""></span>h. Another group of patients with later graft dysfunction required ECMO from the seventh day. The survival rate in the first group was 56%, while none of the patients in the second group were able to survive.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">At present, ECMO use in LT is accepted in three stages of the perioperative period: as a bridge to transplantation, during surgery, and in the postoperative period.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Extracorporeal membrane oxygenation as a bridge to lung transplantation</span><p id="par0040" class="elsevierStylePara elsevierViewall">The use of ECMO in patients on the waiting list is subject to controversy. Some centers consider ECMO to be a contraindication to LT. However, in the light of the recent technological advances, some authors estimate that a relative safety period in this stage of 4–6 weeks of ECMO would be reasonable until a lung donor is found.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In the year 2012, the Vienna group<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> published 38 cases of ECMO used as a bridge to LT. Four patients died before transplantation proved possible, and the rest of the patients could be operated upon. Of these, 8 died in hospital after a mean stay of 24.5 days (range 1–180 days). The survival rate after 1, 3 and 5 years among all the transplanted patients were 60%, 60% and 48%, respectively.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In 2007, Aigner et al. also published two cases of ECMO VA as a bridge to LT in patients with decompensation due to cystic fibrosis.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> One patient died 2 months after surgery due to sepsis, while the other showed prolonged survival.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Although different studies have reported the survival rate of patients subjected to ECMO to be 40% after 12 months, in recent years there have been important advances in the technical aspects of ECMO that have made it possible to obtain better results. The use of polymethylpentene (PMP) oxygenators and of new centrifuge pumps has led to a decrease in failures and in technical problems during handling of the system. Accordingly, the blood transfusion and blood product requirements have decreased considerably, thereby improving gas exchange, reducing the frequency of oxygenator failure, and improving the safety of the device.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15–17</span></a> In addition, the incorporation of a heat exchanger and the lesser priming volumes of ECMO undoubtedly have contributed to improve the results.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Recent studies have reported high survival rates in the preoperative period. In this context, Hämmäinen et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> used both ECMO VV and ECMO VA in 16 patients. Of these subjects, three died with ECMO while waiting for a donor, another patient died 82 days after transplantation, and the survival rate after 1 year in the rest of the transplanted patients was 92%–with a mean duration of ECMO of 16.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>19.2 days.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The technological advances are also leading to experience in the utilization of ECMO in patients on the waiting list and maintaining spontaneous respiration without the need for mechanical ventilation, sedation and immobilization,<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19–21</span></a> thereby even allowing the patients to undergo muscle rehabilitation and to thus face surgery under better clinical conditions. Likewise, the use of ECMO is being incorporated in patients on the LT waiting list who present severe clinical deterioration even in centers located at a considerable distance from the transplanting center–with very encouraging results.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Patients with idiopathic pulmonary arterial hypertension (PHT) present a high mortality risk (20–30%) while on the waiting list.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23–25</span></a> Many of these patients present right ventricle failure requiring improvement of the hemodynamic conditions and of the dysfunction of other organs (e.g., liver, kidney). The Ontario group has published its experience from 2006 to 2010 with this group of patients requiring extracorporeal support while on the waiting list. Their results show ECMO to be an excellent choice as a bridge to LT, making it possible to reduce mortality during this period, and with no increase in postoperative mortality or increased risk of graft dysfunction.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Regarding the middle-term survival of the patients requiring ECMO as a bridge to transplantation, a number of studies have reported survival rates of 74% and 65% after 1 and 3 years, respectively, with no differences in lung function beyond 1 year of follow-up, since the respiratory function test results (FVC and FEV<span class="elsevierStyleInf">1</span>) were similar to those of patients who had not required ECMO in the pretransplantation period.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Extracorporeal membrane oxygenation during surgery</span><p id="par0075" class="elsevierStylePara elsevierViewall">Intraoperatively, most groups continue to use extracorporeal circulation in the presence of important respiratory and/or hemodynamic alterations. However, other authors recommend the use of ECMO as a prophylactic measure in cases of severe pulmonary hypertension. Thus, Pereszlenyi et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> published their experience with 17 patients diagnosed with severe pulmonary hypertension subjected to ECMO in the intra- and postoperative period. In most patients the assist was implanted following anesthetic induction. In three cases the device could be removed after the intervention, while in 14 patients ECMO was suspended 12<span class="elsevierStyleHsp" style=""></span>h after the operation. The mean stay in Critical Care was 12 days. The final results referred to survival were two deaths in the postoperative period (days 7 and 140), while the rest of the patients were still alive after one and a half years of follow-up.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The same group<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> has published its experience from 2001 to 2006, with a total of 306 lung transplants. Of these patients, 147 received ECMO, and in 130 patients the device was implanted intraoperatively. The results showed a survival rate of about 74% in the ECMO group, which was not significantly greater than that recorded in the group requiring cardiopulmonary bypass.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Likewise, Ling-feng et al.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> recommend the use of ECMO instead of cardiopulmonary bypass, since it is associated with a lesser risk of bleeding, lesser primary graft dysfunction, and a lesser inflammatory response.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Extracorporeal membrane oxygenation in the postoperative period</span><p id="par0090" class="elsevierStylePara elsevierViewall">ECMO plays an important role in the postoperative period of LT. The presence of complications such as primary graft dysfunction (PGD), hyperacute rejection, and hemodynamic alterations are the main reasons for introducing ECMO. The latter is considered adequate for providing cardiorespiratory support in patients with pulmonary and cardiac dysfunction after transplantation, and once the conventional management options are found to be ineffective. PGD is defined by the presence of non-cardiogenic, reperfusion lung edema secondary to lung parenchymal alterations accompanied by an increase in pulmonary vascular resistances, a decrease in compliance, increased capillary permeability, alveolar-interstitial edema, and oxygenation alterations. If not quickly and adequately treated, the persistent hypoxemia can give rise to hemodynamic instability and multiorgan failure. Severe cases of dysfunction are usually accompanied by important hemodynamic alterations due to right ventricle failure that worsen the prognosis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Ischemia-reperfusion damage is the main determinant of PGD, though some data suggest that many other factors such as prolonged ischemia time, preservation quality, the need for abundant blood transfusions, prolonged bypass, etc., can exacerbate or induce PGD. Different degrees of dysfunction intensity can be observed (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Severe PGD is recorded in 2–4% of the patients after the operation, and ECMO is used either to allow recovery from organ damage or as a bridge to retransplantation.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,30</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">According to the International Society for Heart and Lung Transplantation, lung graft failure is responsible for one-third of the postoperative (30 days) mortality and for 15% of the deaths occurring in the first 3 months in LT patients<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>–though it also produces an important increase in postoperative morbidity.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Few studies have been published on the use of ECMO in situations of PGD.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> Undoubtedly, the reasons for such a low incidence in the use of ECMO after LT can be explained by: (a) improvements in preservation strategies, using fluids and added substances that avoid the presence and formation of free radicals–avoiding greater lung injury; (b) prospective availability of the cross-matching results (T and B cells); (c) the increasingly lesser use of intraoperative cardiopulmonary bypass; and (d) improvement in the mechanical ventilation techniques, using pulmonary protection measures, and with the increasingly widespread use of differential ventilation in cases of unilateral graft dysfunction.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Primary pulmonary hypertension, chronic obstructive pulmonary disease and retransplantation are associated with an increased risk of PGD and the need for ECMO.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Hartwig et al. published<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> their results after the use of ECMO VV versus VA due to post-LT PGD. After 30 days the survival rate was 88% in the group of patients in which ECMO VV had been used. The authors found the complications to be greater, and survival lower (6%), in the patients requiring ECMO VA. The advantages of venovenous cannulation versus venoarterial cannulation have been described in many studies.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30,34,35</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">It is interesting to know the long-term results referred to graft functionality and survival among patients who required ECMO because of PGD. Dahlberg et al.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> reported an acceptable middle-term survival rate in 16 patients treated with ECMO due to PGD after LT. The survival rate after 2 years was 46% versus 69% among the 172 patients who did not require ECMO. In this same study the authors found LT graft function as reflected by FEV<span class="elsevierStyleInf">1</span> to be 59<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13% of the theoretical value in the ECMO group after 1 year, versus 60<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15% of the theoretical value after 2 years.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The group supervised by Hartwig et al.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> has published its experience in patients requiring ECMO VV following transplantation because of PGD. The survival rates after one and 5 years were 64% and 49%, respectively. A total of 88% of the survivors who required ECMO remained free of bronchiolitis obliterans after 3 years, though graft function was considerably better in the group of patients who did not need ECMO in the postoperative period (FEV<span class="elsevierStyleInf">1</span> 58% in the ECMO group versus 83% in the non-ECMO group).</p><p id="par0125" class="elsevierStylePara elsevierViewall">The Pittsburgh group<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> in turn has published its long-term results (15 years) referred to graft quality and survival in patients subjected to ECMO VV or ECMO VA. Although the mortality rate was higher among the patients requiring ECMO because of PGD in comparison with the patients who did not need such support, the authors also found that the survivors had graft functionality results similar to those of the patients who did not require ECMO. Likewise, they found no significant differences between the assist techniques used (ECMO VV versus ECMO VA).</p><p id="par0130" class="elsevierStylePara elsevierViewall">The Wisconsin group<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> also underscores the importance of using ECMO in PGD, with survival rates after 1 month, 1 year and 3 years of 74.6%, 54% and 36%, respectively.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Another of the early complications in LT is hyperacute rejection, which is produced by an antibody-mediated immune response to the graft. These antibodies are targeted to the HLA antigen of the donor. Hyperacute rejection is characterized by: (a) the development of lung edema and bleeding immediately after transplantation; (b) the presence of antibodies against antigens of the major histocompatibility complex (HLA I and II); (c) histological findings of interstitial neutrophilia and diffuse alveolar damage, sometimes accompanied by platelet and fibrin thrombi and small-vessel vasculitis; and (d) a rapidly progressing, fatal outcome.</p><p id="par0140" class="elsevierStylePara elsevierViewall">From the clinical and radiological point of view, the characteristics of ischemia-reperfusion damage and hyperacute rejection are identical. It is therefore likely that cases of antibody-mediated rejection have been registered as primary graft failure. The group directed by Mason et al. extends the use of ECMO after LT to graft rejection, with an immediate postoperative survival rate of about 60%.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> Likewise, the Austrian group<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> has published its experience with three patients suffering severe acute rejection. They temporarily used venoarterial and femoro-femoral ECMO, observing advantages in terms of hemodynamic and respiratory stability, and making it possible to reduce the need for aggressive mechanical ventilation. Two of the patients were still alive after 30 and 60 months of follow-up, with no bronchiolitis obliterans.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Complications</span><p id="par0145" class="elsevierStylePara elsevierViewall">The complications of ECMO have gradually decreased as a result of the technological improvements of the latest assist models, but problems nevertheless remain frequent.<span class="elsevierStyleItalic">Hemorrhage:</span> This can be produced by many factors, such as coagulation disorders caused by the continuous administration of heparin and platelet dysfunction<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a>; alternatively, a defect in the surgical technique can produce bleeding at the cannulation site. Reoperation due to bleeding is not uncommon. Recently, a publication has been made of the experience gained using ECMO without anticoagulation, due to the risk of bleeding.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a><span class="elsevierStyleItalic">Thromboembolism:</span> This is the result of clot formation in the extracorporeal circuit. It is essential to regularly inspect the circuit in search of clotting. Likewise, a rise in pressure gradient across the oxygenator suggests thrombus formation in this part of the extracorporeal circuit. In the event of signs of circuit clotting, the circuit must be replaced. <span class="elsevierStyleItalic">Infection:</span> This is one of the most frequent complications–hence the importance of prophylaxis and of the monitoring of signs of infection, in order to ensure adequate antibiotherapy as quickly as possible. Inadequate and late treatment of sepsis can give rise to multiorgan failure, which greatly complicates the management of patients subjected to ECMO. Smedira et al.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> recorded a 49% infection rate in 202 patients assisted with ECMO. <span class="elsevierStyleItalic">Neurological complications:</span> These complications are the most frequent primary cause of death according to the INTERMACS registry.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> They tend to be secondary to embolic or bleeding problems, and have devastating effects.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a><span class="elsevierStyleItalic">Vascular and mechanical complications</span>: These problems involve particularly arterial rupture or dissection, ischemia of the lower extremity in which the cannula has been placed, phlegmasia or tension edema of the lower extremity secondary to obstruction of venous return along the venous femoral cannula, right ventricle rupture due to complications in placement of the cannula, tamponade, etc.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">46–49</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0150" class="elsevierStylePara elsevierViewall">Although ECMO is relatively little used in LT, and the literature moreover does not refer to large patient series, the technical improvements in the devices and the results obtained are causing the technique to become increasingly popular. Artificial devices offer pulmonary and circulatory support that contribute to lessen morbidity–mortality among selected patients during the different phases of the perioperative period. The use of ECMO is becoming increasingly consolidated in the different transplant groups, since there is presently less controversy regarding the use of ECMO-based cardiorespiratory assist procedures as an alternative for patients on the waiting list, applied during the intra- and postoperative periods of LT.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres194428" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec181002" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres194429" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec181001" "titulo" => "Palabras clave" ] 4 => array:3 [ "identificador" => "sec0005" "titulo" => "Introduction" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Extracorporeal membrane oxygenation as a bridge to lung transplantation" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Extracorporeal membrane oxygenation during surgery" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Extracorporeal membrane oxygenation in the postoperative period" ] ] ] 5 => array:2 [ "identificador" => "sec0025" "titulo" => "Complications" ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-04-19" "fechaAceptado" => "2012-06-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec181002" "palabras" => array:3 [ 0 => "Extracorporeal membrane oxygenation" 1 => "Lung transplantation" 2 => "Complications" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec181001" "palabras" => array:3 [ 0 => "Oxigenador de membrana extracorpóreo" 1 => "Trasplante pulmonar" 2 => "Complicaciones" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The use of extracorporeal techniques in cardiopulmonary support has spread in the last 20 years. extracorporeal membrane oxygenation (ECMO) devices are the most commonly employed option, and have been used for years in lung transplant programs. Nevertheless, few articles on the results of ECMO involving large numbers of cases have been published to date. The use of ECMO in respiratory failure affords immediate oxygen support in patients with severe hypoxia and/or acidosis, and moreover provides pulmonary protection, since it allows an instantaneous decrease in the ventilator pressure and FiO<span class="elsevierStyleInf">2</span> needs. The complications of ECMO have been minimized thanks to the technological improvements found in the latest devices, though renal failure, infections, bleeding, and vascular and mechanical complications are still reported in many studies. At present there is less controversy regarding the use of cardiorespiratory assists with ECMO as an alternative in decompensated patients who are on the waiting list, referred to the intra- and postoperative periods of lung transplantation.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El uso de tecnologías extracorpóreas en el soporte cardiopulmonar se ha extendido en los últimos 20 años. Los dispositivos oxigenador de membrana extracorpóreo (ECMO) son los más utilizados y se emplean desde hace años en los programas de trasplante pulmonar. Sin embargo, hay pocos artículos con series amplias de resultados de ECMO. El empleo del ECMO en el fallo respiratorio, además de otorgar un soporte inmediato de oxígeno en pacientes severamente hipoxémicos y/o acidóticos, proporciona protección pulmonar ya que permite la disminución instantánea en las necesidades de presiones y FiO<span class="elsevierStyleInf">2</span> en el ventilador. Las complicaciones del uso de ECMO han ido minimizándose con las mejoras técnicas que presentan los últimos modelos de las asistencias, pero la insuficiencia renal, las infecciones, hemorragias y las complicaciones vasculares y mecánicas siguen siendo referidas en numerosos trabajos. Existen actualmente menos controversias en el empleo de la asistencia cardiorrespiratoria con ECMO como alternativa para pacientes descompensados que están en lista de espera, para el intraoperatorio y postoperatorio del trasplante pulmonar.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Vicente R, et al. Oxigenador de membrana extracorpóreo en el trasplante pulmonar. Med Intensiva. 2013.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Respiratory criteria</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Rapid entry</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PaO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>mmHg during 2<span class="elsevierStyleHsp" style=""></span>h at FiO<span class="elsevierStyleInf">2</span> 1, PEEP<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Slow entry</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PaO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>mmHg during 12<span class="elsevierStyleHsp" style=""></span>h at FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.6, PEEP<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Other criteria</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Transpulmonary shunt<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>30% with FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.6 and compliance<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.5<span class="elsevierStyleHsp" style=""></span>ml/cmH<span class="elsevierStyleInf">2</span>O/kg \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Obstructive airway disease</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Uncorrectable severe hypercapnia, pH</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">7 and end-inspiratory pressure</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">45</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mmHg</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Hemodynamic criteria</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cardiac index</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">1.8</span>–<span class="elsevierStyleItalic">2</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">l/m/m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span>. <span class="elsevierStyleItalic">Pulmonary capillary pressure</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">20</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mmHg</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Blood pressure</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">90</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mmHg</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab332504.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Extracorporeal membrane oxygenation entry criteria.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Degree \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Lung edema \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>300 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Absent \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>300 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Present \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">200–300 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Present \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Present \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab332503.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Degrees of primary graft dysfunction.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:49 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Registry of the International Society for Heart and Lung Transplantation: twenty-eighth adult lung and heart–lung transplant report-2011" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.D. Christie" 1 => "L.B. Edwards" 2 => "A.Y. Kucheryavaya" 3 => "C. Benden" 4 => "F. Dobbels" 5 => "R. Kirk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.healun.2011.08.004" "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "2011" "volumen" => "30" "paginaInicial" => "1104" "paginaFinal" => "1122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21962018" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extended donor criteria in lung transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Botha" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Opin Organ Transplant" "fecha" => "2009" "volumen" => "14" "paginaInicial" => "206" "paginaFinal" => "210" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19469042" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung procurement for transplantation: new criteria for lung donor selection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.P. Moretti" 1 => "C. Betto" 2 => "M. Gambacorta" 3 => "S. Vesconi" 4 => "M. Scalamogna" 5 => "E. Benazzi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.transproceed.2010.03.103" "Revista" => array:6 [ "tituloSerie" => "Transplant Proc" "fecha" => "2010" "volumen" => "42" "paginaInicial" => "1053" "paginaFinal" => "1055" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20534222" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical lung transplantation from uncontrolled non-heart-beating donors revisited" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Gómez-de-Antonio" 1 => "J.L. Campo-Cañaveral" 2 => "S. Crowley" 3 => "D. Valdivia" 4 => "M. Córdoba" 5 => "J. Moradiellos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.healun.2011.12.007" "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "2012" "volumen" => "31" "paginaInicial" => "349" "paginaFinal" => "353" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22306439" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of lung transplant survival in Euro Transplant" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.M. Smits" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Transplant" "fecha" => "2003" "volumen" => "3" "paginaInicial" => "1400" "paginaFinal" => "1406" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14525601" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortality is directly related to the duration of mechanical ventilation before the initiation of extracorporeal life support for severe respiratory failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Pranikoff" 1 => "R.B. Hirschl" 2 => "C.N. Steimle" 3 => "H.L. Anderson 3rd" 4 => "R.H. Bartlett" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Crit Care Med" "fecha" => "1997" "volumen" => "24" "paginaInicial" => "28" "paginaFinal" => "32" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.J. Peek" 1 => "M. Mugford" 2 => "R. Tiruvoipati" 3 => "A. Wilson" 4 => "E. Allen" 5 => "M.M. Thalanany" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(09)61069-2" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2009" "volumen" => "374" "paginaInicial" => "1351" "paginaFinal" => "1363" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19762075" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracorporeal membrane oxygenation for primary graft dysfunction after lung transplantation: analysis of the Extracorporeal Life Support Organization (ELSO) registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Fischer" 1 => "D. Bohn" 2 => "P. Rycus" 3 => "A.F. Pierre" 4 => "M. de Perrot" 5 => "T.K. Waddell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.healun.2007.01.031" "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "2007" "volumen" => "26" "paginaInicial" => "472" "paginaFinal" => "477" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17449416" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung transplantation following 107 days of extracorporeal membrane oxygenation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Iacono" 1 => "S. Groves" 2 => "J. Garcia" 3 => "B. Griffith" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejcts.2009.09.039" "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2010" "volumen" => "37" "paginaInicial" => "969" "paginaFinal" => "971" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19896387" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prolonged extracorporeal membrane oxygenation and circulatory support as bridge to lung transplant" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Broomé" 1 => "K. Palmér" 2 => "H. Scherstén" 3 => "B. Frenckner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2008.03.053" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2008" "volumen" => "86" "paginaInicial" => "1357" "paginaFinal" => "1360" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18805197" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Temporary ECMO support following lung and heart–lung transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.Q. Nguyen" 1 => "D.M. Kulick" 2 => "R.M. Bolman 3rd" 3 => "J.M. Dunitz" 4 => "M.I. Hertz" 5 => "S.J. Park" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "2000" "volumen" => "19" "paginaInicial" => "313" "paginaFinal" => "316" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10713257" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of extracorporeal membrane oxygenation as a bridge to primary lung transplant: 3 consecutive, successful cases and a review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Jackson" 1 => "J. Cropper" 2 => "R. Pye" 3 => "F. Junius" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.healun.2007.12.006" "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "2008" "volumen" => "27" "paginaInicial" => "348" "paginaFinal" => "352" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18342760" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary lung transplantation after bridge with extracorporeal membrane oxygenation: a plea for a shift in our paradigms for indications" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Lang" 1 => "S. Taghavi" 2 => "C. Aigner" 3 => "F. Rényi-Vámos" 4 => "P. Jaksch" 5 => "V. Augustin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TP.0b013e318246f8e1" "Revista" => array:6 [ "tituloSerie" => "Transplantation" "fecha" => "2012" "volumen" => "93" "paginaInicial" => "729" "paginaFinal" => "736" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22415051" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Institutional experience with extracorporeal membrane oxygenation in lung transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Aigner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejcts.2006.11.049" "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2007" "volumen" => "31" "paginaInicial" => "468" "paginaFinal" => "473" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17223352" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early experience with a polymethyl pentene oxygenator for adult extracorporeal life support" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G. Peek" 1 => "H. Killer" 2 => "R. Reeves" 3 => "A.W. Sosnowski" 4 => "R.K. Firmin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "ASAIO J" "fecha" => "2002" "volumen" => "48" "paginaInicial" => "480" "paginaFinal" => "482" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12296566" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Poly-methyl pentene oxygenators have improved gas exchange capability and reduced transfusion requirements in adult extracorporeal membrane oxygenation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Khoshbin" 1 => "N. Roberts" 2 => "C. Harvey" 3 => "D. Machin" 4 => "H. Killer" 5 => "G.J. Peek" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "ASAIO J" "fecha" => "2005" "volumen" => "51" "paginaInicial" => "281" "paginaFinal" => "287" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15968960" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemolytic characteristics of three commercially available centrifugal blood pumps" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.S. Lawson" 1 => "R. Ing" 2 => "I.M. Cheifetz" 3 => "R. Walczak" 4 => "D. Craig" 5 => "S. Schulman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatr Crit Care Med" "fecha" => "2005" "volumen" => "6" "paginaInicial" => "573" "paginaFinal" => "577" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16148820" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Usefulness of extracorporeal membrane oxygenation as a bridge to lung transplantation: a descriptive study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Hämmäinen" 1 => "H. Schersten" 2 => "K. Lemström" 3 => "G.C. Riise" 4 => "S. Kukkonen" 5 => "Swärd J.F K." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.healun.2010.08.017" "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "2011" "volumen" => "30" "paginaInicial" => "103" "paginaFinal" => "107" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20934887" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Fuehner" 1 => "C. Kuehn" 2 => "J. Hadem" 3 => "O. Wiesner" 4 => "J. Gottlieb" 5 => "I. Tudorache" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201109-1599OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2012" "volumen" => "185" "paginaInicial" => "763" "paginaFinal" => "768" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22268135" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracorporeal membrane oxygenation in nonintubated patients as bridge to lung transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.M. Olsson" 1 => "A. Simon" 2 => "M. Strueber" 3 => "J. Hadem" 4 => "O. Wiesner" 5 => "J. Gottlieb" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-6143.2010.03192.x" "Revista" => array:6 [ "tituloSerie" => "Am J Transplant" "fecha" => "2010" "volumen" => "10" "paginaInicial" => "2173" "paginaFinal" => "2178" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20636463" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bridge to lung transplantation using short-term ambulatory extracorporeal membrane oxygenation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.A. Mangi" 1 => "D.P. Mason" 2 => "J.J. Yun" 3 => "S.C. Murthy" 4 => "G.B. Pettersson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtcvs.2010.02.029" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2010" "volumen" => "140" "paginaInicial" => "713" "paginaFinal" => "715" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20381081" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracorporeal circulatory systems as a bridge to lung transplantation at remote transplant centers" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Haneya" 1 => "A. Philipp" 2 => "T. Mueller" 3 => "M. Lubnow" 4 => "M. Pfeifer" 5 => "W. Zink" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2010.09.005" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2011" "volumen" => "91" "paginaInicial" => "250" "paginaFinal" => "256" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21172523" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracorporeal membrane oxygenation as a bridge to emergency heart–lung transplantation in a patient with idiopathic pulmonary arterial hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I. Gregoric" 1 => "D. Chandra" 2 => "T.J. Myers" 3 => "S.A. Scheinin" 4 => "P. Loyalka" 5 => "B. Kar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.healun.2008.01.016" "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "2008" "volumen" => "27" "paginaInicial" => "466" "paginaFinal" => "468" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18374886" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Veno-venous extracorporeal membrane oxygenation with interatrial shunting: a novel approach to lung transplantation for patients in right ventricular failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Camboni" 1 => "B. Akay" 2 => "J.R. Pohlmann" 3 => "K.L. Koch" 4 => "J.W. Haft" 5 => "R.H. Bartlett" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtcvs.2010.08.092" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2011" "volumen" => "141" "paginaInicial" => "537" "paginaFinal" => "542" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21241864" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation International guidelines for the selection of lung transplant candidates: 2006 update—a consensus report from the Pulmonary Scientific" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.B. Orens" 1 => "M. Estenne" 2 => "S. Arcasoy" 3 => "J.V. Conte" 4 => "P. Corris" 5 => "J.J. Egan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.healun.2006.03.011" "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "2006" "volumen" => "25" "paginaInicial" => "745" "paginaFinal" => "755" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16818116" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of extracorporeal life support on outcome in patients with idiopathic pulmonary arterial hypertension awaiting lung transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Perrot" 1 => "J. Granton" 2 => "K. McRae" 3 => "M. Cypel" 4 => "A. Pierre" 5 => "T.K. Waddell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.healun.2011.03.002" "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "2011" "volumen" => "30" "paginaInicial" => "997" "paginaFinal" => "1002" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21489818" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracorporeal membrane oxygenation as a bridge to lung transplant: midterm outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.A. Bermudez" 1 => "R.V. Rocha" 2 => "D. Zaldonis" 3 => "J.K. Bhama" 4 => "M.M. Crespo" 5 => "N. Shigemura" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2011" "volumen" => "92" "paginaInicial" => "1231" "paginaFinal" => "1232" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bilateral lung transplantation with intra- and postoperatively prolonged ECMO support in patients with pulmonary hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Pereszlenyi" 1 => "G. Lang" 2 => "H. Steltzer" 3 => "H. Hetz" 4 => "A. Kocher" 5 => "P. Neuhauser" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2002" "volumen" => "21" "paginaInicial" => "858" "paginaFinal" => "863" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12062275" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracorporeal membrane oxygenation during double-lung transplantation: single center experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "X.U. Ling-feng" 1 => "L.I. Xin" 2 => "G.U.O. Zhen" 3 => "X.U. Mei-yin" 4 => "G.A.O. Cheng-xin" 5 => "Z.H.U. Jin-hong" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chin Med J" "fecha" => "2010" "volumen" => "123" "paginaInicial" => "269" "paginaFinal" => "273" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20193243" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improved results treating lung allograft failure with venovenous extracorporeal membrane oxygenation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.G. Hartwig" 1 => "J.Z. Appel 3rd" 2 => "E. Cantu 3rd" 3 => "S. Simsir" 4 => "S.S. Lin" 5 => "C.C. Hsieh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2005.04.063" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2005" "volumen" => "80" "paginaInicial" => "1872" "paginaFinal" => "1880" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16242472" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Registry of the International Society for Heart and Lung Transplantation: twenty-fourth official adult lung and heart–lung transplantation report—2007" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.P. Trulock" 1 => "J.D. Christie" 2 => "L.B. Edwards" 3 => "M.M. Boucek" 4 => "P. Aurora" 5 => "D.O. Taylor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.healun.2007.06.003" "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "2007" "volumen" => "26" "paginaInicial" => "782" "paginaFinal" => "795" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17692782" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medium-term results of extracorporeal membrane oxygenation for severe acute lung injury after lung transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P.S. Dahlberg" 1 => "M.E. Prekker" 2 => "C.S. Herrington" 3 => "M.I. Hertz" 4 => "S.J. Park" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.healun.2003.08.021" "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "2004" "volumen" => "23" "paginaInicial" => "979" "paginaFinal" => "984" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15312828" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Selective use of extracorporeal membrane oxygenation is warranted after lung transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.F. Meyers" 1 => "T.M. Sundt 3rd" 2 => "S. Henry" 3 => "E.P. Trulock" 4 => "T. Guthrie" 5 => "J.D. Cooper" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mtc.2000.105639" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2000" "volumen" => "120" "paginaInicial" => "20" "paginaFinal" => "26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10884650" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognosis and outcome of neonates treated ither with veno-arterial (VA) or veno-venous (VV) ECMO" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Varnholt" 1 => "P. Lasch" 2 => "J. Sartoris" 3 => "W. Koelfen" 4 => "W. Kachel" 5 => "C. Lorenz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Artif Organs" "fecha" => "1995" "volumen" => "18" "paginaInicial" => "569" "paginaFinal" => "573" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8647585" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracorporeal life support: the University of Michigan experience" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.H. Bartlett" 1 => "D.W. Roloff" 2 => "J.R. Custer" 3 => "J.G. Younger" 4 => "R.B. Hirschl" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2000" "volumen" => "283" "paginaInicial" => "904" "paginaFinal" => "908" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10685715" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improved survival but marginal allograft function in patients treated with extracorporeal membrane oxygenation after lung transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.G. Hartwig" 1 => "R. Walczak" 2 => "S.S. Lin" 3 => "R.D. Davis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2011.05.017" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2012" "volumen" => "93" "paginaInicial" => "366" "paginaFinal" => "371" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21962264" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracorporeal membrane oxygenation for primary graft dysfunction after lung transplantation: long-term survival" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.A. Bermudez" 1 => "P.S. Adusumilli" 2 => "K.R. McCurry" 3 => "D. Zaldonis" 4 => "M.M. Crespo" 5 => "J.M. Pilewski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2008.11.036" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2009" "volumen" => "87" "paginaInicial" => "854" "paginaFinal" => "860" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19231405" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early institution of extracorporeal membrane oxygenation for primary graft dysfunction after lung transplantation improves outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.H. Wigfield" 1 => "J.D. Lindsey" 2 => "T. Steffens.T.G." 3 => "N.M. Edwards" 4 => "R.B. Love" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.healun.2006.12.010" "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "2007" "volumen" => "26" "paginaInicial" => "331" "paginaFinal" => "338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17403473" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extended use of extracorporeal membrane oxygenation after lung transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Mason" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtcvs.2006.06.010" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2006" "volumen" => "132" "paginaInicial" => "954" "paginaFinal" => "960" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17000310" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of severe acute lung allograft rejection with OKT3 and temporary extracorporeal membrane oxygenation bridging" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Aigner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2004" "volumen" => "25" "paginaInicial" => "184" "paginaFinal" => "187" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14747110" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired disorders of platelet function" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B.A. Konkle" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Hematol Am Soc Hematol Educ Program" "fecha" => "2011" "volumen" => "2011" "paginaInicial" => "391" "paginaFinal" => "396" ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0210" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Weaning from venovenous extracorporeal membrane oxygenation without anticoagulation: is it possible?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Lappa" 1 => "S. Donfrancesco" 2 => "C. Contento" 3 => "E. Vitalini" 4 => "P. Pisani" 5 => "A. Menichetti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2012.01.032" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2012" "volumen" => "94" "paginaInicial" => "1" "paginaFinal" => "3" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22429669" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0215" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical experience with 202 adults receiving extracorporeal membrane oxygenation for cardiac failure: survival at five years" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.G. Smedira" 1 => "N. Moazami" 2 => "C.M. Golding" 3 => "P.M. McCarthy" 4 => "C. Apperson-Hansen" 5 => "E.H. Blackstone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mtc.2001.114351" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2001" "volumen" => "122" "paginaInicial" => "92" "paginaFinal" => "102" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11436041" "web" => "Medline" ] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0220" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Fourth INTERMACS Annual Report: 4,000 implants and counting" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.K. Kirklin" 1 => "D.C. Naftel" 2 => "R.L. Kormos" 3 => "L.W. Stevenson" 4 => "F.D. Pagani" 5 => "M.A. Miller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.healun.2011.12.001" "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "2012" "volumen" => "31" "paginaInicial" => "117" "paginaFinal" => "126" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22305376" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0225" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical review: extracorporeal membrane oxygenation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Gattinoni" 1 => "E. Carlesso" 2 => "T. Langer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc10490" "Revista" => array:5 [ "tituloSerie" => "Crit Care" "fecha" => "2011" "volumen" => "15" "paginaInicial" => "243" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22188792" "web" => "Medline" ] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0230" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Late vascular complications after extracorporeal membrane oxygenation support" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Zimpfer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2005.09.066" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2006" "volumen" => "81" "paginaInicial" => "892" "paginaFinal" => "895" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16488690" "web" => "Medline" ] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0235" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vascular complications in patients undergoing femoral cannulation for extracorporeal membrane oxygenation support" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Bisdas" 1 => "G. Beutel" 2 => "G. Warnecke" 3 => "M.M. Hoeper" 4 => "C. Kuehn" 5 => "A. Haverich" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2011.02.018" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2011" "volumen" => "92" "paginaInicial" => "626" "paginaFinal" => "631" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21550582" "web" => "Medline" ] ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0240" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracorporeal membrane oxygenation for treatment of cardiac failure in adult patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "X.J. Luo" 1 => "W. Wang" 2 => "S.S. Hu" 3 => "H.S. Sun" 4 => "H.W. Gao" 5 => "C. Long" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1510/icvts.2008.197681" "Revista" => array:6 [ "tituloSerie" => "Interact Cardiovasc Thorac Surg" "fecha" => "2009" "volumen" => "9" "paginaInicial" => "296" "paginaFinal" => "300" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19351687" "web" => "Medline" ] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0245" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Right ventricular rupture and tamponade caused by malposition of the Avalon cannula for venovenous extracorporeal membrane oxygenation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Hirose" 1 => "K. Yamane" 2 => "G. Marhefka" 3 => "N.J. Cavarocchi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1749-8090-7-36" "Revista" => array:5 [ "tituloSerie" => "J Cardiothorac Surg" "fecha" => "2012" "volumen" => "7" "paginaInicial" => "36" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22515939" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000003700000002/v3_201306280954/S2173572713000155/v3_201306280954/en/main.assets" "Apartado" => array:4 [ "identificador" => "5361" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Update in Intensive Care: Trasplants" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000003700000002/v3_201306280954/S2173572713000155/v3_201306280954/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572713000155?idApp=WMIE" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 11 | 19 |
| 2024 October | 52 | 51 | 103 |
| 2024 September | 72 | 34 | 106 |
| 2024 August | 86 | 35 | 121 |
| 2024 July | 31 | 20 | 51 |
| 2024 June | 77 | 55 | 132 |
| 2024 May | 49 | 26 | 75 |
| 2024 April | 48 | 36 | 84 |
| 2024 March | 64 | 31 | 95 |
| 2024 February | 73 | 34 | 107 |
| 2024 January | 75 | 30 | 105 |
| 2023 December | 90 | 44 | 134 |
| 2023 November | 81 | 29 | 110 |
| 2023 October | 70 | 27 | 97 |
| 2023 September | 65 | 41 | 106 |
| 2023 August | 59 | 12 | 71 |
| 2023 July | 67 | 21 | 88 |
| 2023 June | 42 | 23 | 65 |
| 2023 May | 46 | 22 | 68 |
| 2023 April | 15 | 3 | 18 |
| 2023 March | 77 | 39 | 116 |
| 2023 February | 67 | 32 | 99 |
| 2023 January | 58 | 24 | 82 |
| 2022 December | 76 | 39 | 115 |
| 2022 November | 98 | 44 | 142 |
| 2022 October | 81 | 39 | 120 |
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| 2021 December | 59 | 56 | 115 |
| 2021 November | 53 | 58 | 111 |
| 2021 October | 65 | 80 | 145 |
| 2021 September | 68 | 56 | 124 |
| 2021 August | 61 | 69 | 130 |
| 2021 July | 49 | 51 | 100 |
| 2021 June | 62 | 52 | 114 |
| 2021 May | 64 | 47 | 111 |
| 2021 April | 175 | 68 | 243 |
| 2021 March | 116 | 53 | 169 |
| 2021 February | 103 | 33 | 136 |
| 2021 January | 71 | 31 | 102 |
| 2020 December | 70 | 43 | 113 |
| 2020 November | 52 | 18 | 70 |
| 2020 October | 67 | 41 | 108 |
| 2020 September | 58 | 22 | 80 |
| 2020 August | 35 | 19 | 54 |
| 2020 July | 45 | 31 | 76 |
| 2020 June | 72 | 25 | 97 |
| 2020 May | 50 | 27 | 77 |
| 2020 April | 43 | 19 | 62 |
| 2020 March | 22 | 15 | 37 |
| 2020 February | 102 | 39 | 141 |
| 2020 January | 40 | 26 | 66 |
| 2019 December | 45 | 24 | 69 |
| 2019 November | 27 | 23 | 50 |
| 2019 October | 46 | 25 | 71 |
| 2019 September | 44 | 26 | 70 |
| 2019 August | 39 | 20 | 59 |
| 2019 July | 51 | 32 | 83 |
| 2019 June | 64 | 17 | 81 |
| 2019 May | 73 | 31 | 104 |
| 2019 April | 52 | 31 | 83 |
| 2019 March | 69 | 34 | 103 |
| 2019 February | 63 | 44 | 107 |
| 2019 January | 59 | 30 | 89 |
| 2018 December | 118 | 39 | 157 |
| 2018 November | 256 | 62 | 318 |
| 2018 October | 179 | 21 | 200 |
| 2018 September | 77 | 8 | 85 |
| 2018 August | 36 | 7 | 43 |
| 2018 July | 57 | 12 | 69 |
| 2018 June | 57 | 13 | 70 |
| 2018 May | 26 | 4 | 30 |
| 2018 April | 47 | 3 | 50 |
| 2018 March | 49 | 6 | 55 |
| 2018 February | 20 | 7 | 27 |
| 2018 January | 50 | 18 | 68 |
| 2017 December | 29 | 5 | 34 |
| 2017 November | 33 | 7 | 40 |
| 2017 October | 36 | 5 | 41 |
| 2017 September | 47 | 8 | 55 |
| 2017 August | 34 | 10 | 44 |
| 2017 July | 28 | 9 | 37 |
| 2017 June | 49 | 11 | 60 |
| 2017 May | 41 | 6 | 47 |
| 2017 April | 39 | 11 | 50 |
| 2017 March | 41 | 16 | 57 |
| 2017 February | 37 | 12 | 49 |
| 2017 January | 33 | 7 | 40 |
| 2016 December | 61 | 16 | 77 |
| 2016 November | 80 | 17 | 97 |
| 2016 October | 86 | 17 | 103 |
| 2016 September | 95 | 40 | 135 |
| 2016 August | 71 | 25 | 96 |
| 2016 July | 48 | 21 | 69 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2014 August | 2 | 0 | 2 |
| 2014 June | 1 | 0 | 1 |
| 2014 May | 3 | 0 | 3 |
| 2014 March | 1 | 0 | 1 |
| 2014 January | 1 | 0 | 1 |
| 2013 December | 1 | 0 | 1 |
| 2013 September | 2 | 0 | 2 |
| 2013 August | 2 | 0 | 2 |
| 2013 July | 3 | 0 | 3 |
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