• bilateral-lung transplantation
• emphysema
• extubation

Background: The aim of this study was to compare adult emphysema patients extubated in the operating room (OR) followed by non-invasive ventilation to patients extubated in the intensive care unit (ICU) after bilateral-lung transplantation (BLT).
Methods: A single-center retrospective database analysis of 91 patients (May 2007-september 2016). Anesthesia was performed using automated titration of propofol and remifentanil combined with thoracic epidural analgesia. Data are expressed as number (percentage) or medians (25th-75th percentile).
Results: Forty-nine (54%) patients were extubated in the OR group with one (2%) requiring reintubation and 42 (46%) in the ICU. Patients, donor and intraoperative characteristics were similar between groups. But the need for or use of intraoperative extracorporeal membrane oxygenation (ECMO) (3 (6) vs 19 (45) patients, p<0.0001) and ex-vivo lung reconditioning (2 (4) vs 9 (21) patients, p=0.021) were lower in the OR group. At the procedure end, the PaO2/FiO2 ratio was better (345 (283-424) vs 209 (156-397), p<0.0001), OR vs ICU group respectively. The need of postoperative ECMO (0(0) vs 9 (21), p<0.0001), mechanical ventilation duration (0 (0-1 vs 7 (2-14) days, p<0.0001), tracheostomy (4 (8) vs 17 (40) patients, p<0.0001), length of stay in the ICU (5 (4-7) vs 12 (7-19) days, p<0.0001) and the rate of grade-3 primary graft dysfunction (2 (4) vs 19 (48), p<0.0001) were lower in the OR group.
Conclusions: Half of the patients were extubated in the OR and they had better outcomes. Ex-vivo lung reconditioning or intraoperative use of ECMO decreased the rate of extubation in the OR.