Extracorporeal membrane oxygenation and lung transplantation

Abstract

The use of extracorporeal membrane oxygenation has had a positive impact on the outcomes after lung transplantation. Extracorporeal membrane oxygenation has a role in all phases of lung transplantation-preoperative, intraoperative, and postoperative periods. It serves as a bridge to transplantation in appropriate patients awaiting lung transplantation. Extracorporeal membrane oxygenation is used as a preferred method of cardiopulmonary support in some centres during implantation; and, after lung transplantation, it can be used to salvage the implanted lung in cases of severe primary graft dysfunction or as a planned extension of intraoperative extracorporeal membrane oxygenation onto the postoperative period. It has now gained acceptance as a mandatory tool in most lung transplant units. This article reviews the history of extracorporeal membrane oxygenation and lung transplantation, their subsequent development, and the current use of extracorporeal membrane oxygenation during lung transplantation. Our institutional practice and experience are described. The implications of the current global coronavirus disease pandemic on extracorporeal membrane oxygenation and lung transplantation are also briefly discussed.

Extracorporeal membrane oxygenation support for lung transplantation: Initial experience in a single center in China and a literature review

“…Extracorporeal membrane oxygenation is an extremely versatile tool in the field of LTx as it can serve as a BTT before transplantation, as a support modality during transplantation, and as a rescue strategy after transplantation (3,(6)(7)(8). The data presented here confirmed the essential role of ECMO in LTx, especially the prominent contribution in the intra-and post-operative periods.…”

“…Extracorporeal membrane oxygenation (ECMO) is used with increasing frequency in LTx to provide prolonged cardiac and respiratory support (5)(6)(7)(8). After careful patient selection and the involvement of a multidisciplinary team, several single-and multi-center studies have reported successful use of ECMO as a bridge to transplantation (BTT) (9)(10)(11)(12) as well as a postoperative rescue strategy for primary graft dysfunction (PGD) (13), which has prompted intraoperative use of ECMO during LTx (7). Encouraging outcomes of ECMO for both shortand long-term intraoperative support have been reported (14-16).…”

A pandemic of acute respiratory distress syndrome—role of lung transplant in coronavirus disease-2019–associated respiratory failure

“…Currently, such rescue transplants are performed for only a small subset of patients with acute or chronic lung diseases after careful candidate selection and optimization [ 10 ]. Using ECMO as a bridge to lung transplant, rather than mechanical ventilation, in patients with refractory respiratory failure has shown to have better postoperative outcomes, perhaps related to the ability to stay awake and participate in rehabilitation [ 11 ].…”

“…The prevalence of pulmonary hypertension is high in this group of patients and it could further escalate the burden of bleeding complications [ 33 ]. Patients needing ECMO or mechanical ventilation bridge to lung transplant have greater operative morbidity and mortality risk [ 10 , 14 ]. Informed decision-making The successful outcome from lung transplantation requires a life-long commitment from the recipient [ 4 , 34 ].…”

Clinical Factors Associated With Failed Weaning From Intraoperative Extracorporeal Membrane Oxygenation Used During Lung Transplantation

“…During LTx surgery, cardiopulmonary bypass (CPB) is used for cardiopulmonary support to prevent hemodynamic compromise due to single-lung ventilation, pulmonary artery clamping, and heart manipulation [3][4][5]. However, the use of CPB during LTx is debated, and recent studies from several LTx centers have reported favorable results using ECMO as an alternative to CPB [1,6].…”