Extracorporeal life support during lung transplantation

Abstract

Lung transplantation surgeries are performed without extracorporeal life support (ECLS) by using an off-pump technique; however, in cases of hypoxemia or hemodynamic instability, intraoperative ECLS may be required. Cardiopulmonary bypass (CPB) has traditionally been the standard practice for ECLS but has been associated with an increased risk of bleeding in the perioperative period, increased transfusion requirements, prolonged postoperative intubation, and possibly primary graft dysfunction. More recently, because of the flexibility of using extracorporeal membrane oxygenation (ECMO) in bridging to transplantation and during postoperative recovery, its use has increased. CPB and ECMO each has advantages and disadvantages; however, because comparisons of CPB and ECMO have been limited to small retrospective observational and single-institution studies, more research is required to determine the superiority of one modality. In this review, we critically examine the pros and cons of performing lung transplantation surgery off-pump or by using the ECLS modalities of ECMO and CPB support during lung transplantation surgery.

Current status and future directions in the development and optimization of thoracic and abdominal artificial organs

“…Early membrane oxygenators were stationary and used almost exclusively to perform gas exchange during open‐heart procedures. Currently, extracorporeal membrane oxygenation (ECMO) is widely used as a bridge to transplantation (BTT) in patients with acute or acute‐on‐chronic advanced lung failure 3 . Although the ECMO circuit is traditionally large with low portability, the introduction of single‐site cannulation has greatly enhanced patient mobility 4 .…”

“…Currently, extracorporeal membrane oxygenation (ECMO) is widely used as a bridge to transplantation (BTT) in patients with acute or acute-on-chronic advanced lung failure. 3 Although the ECMO circuit is traditionally large with low portability, the introduction of single-site cannulation has greatly enhanced patient mobility. 4 Paracorporeal AL support features a small circuit device designed to be carried on the patient's body, allowing for unassisted ambulation.…”