Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplant

Abstract

Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary technology capable of supporting cardiac and respiratory function in the presence of end-stage lung disease. Initial experiences using ECMO as a bridge to lung transplant (ECMO-BTLT) were characterized by high rates of ECMO-associated complications and poor posttransplant outcomes. More recently, ECMO-BTLT has garnered success in preserving patients' physiologic condition and candidacy prior to lung transplant due to technological advances and improved management. Despite recent growth, clinical practice surrounding use of ECMO-BTLT remains variable, with little data to inform optimal patient selection and management. Although many questions remain, the use of ECMO-BTLT has shown promising outcomes suggesting that ECMO-BTLT can be an effective strategy to ensure that complex and rapidly decompensating patients with end-stage lung disease can be safely transplanted with good outcomes. Further studies are needed to refine and inform practice patterns, management, and lung allocation in this high-risk and fragile patient population.

Lung Transplantation: Selection of Candidates

“…However, given the frequency of ARDS, several criteria can assist in transplant evaluation. Prognostic factors associated with recovery post-transplant in ARDS include younger age, the absence of medical comorbidities or extra-pulmonary dysfunction, an underlying pulmonary cause of ARDS, and the use of extracorporeal life support as a bridge to transplant [169,170]. One factor associated with increased early mortality is ICU acquired muscle weakness [171].…”

Extracorporeal membrane oxygenation and rehabilitation in patients with COVID‐19: A scoping review

“…It also represents a viable alternative to intubation in patients developing acute respiratory failure while waiting on the list to receive an organ. 4 , 5 , 6 As outlined in the 2021 updated guidelines from the Extracorporeal Life Support Organization, the role of ECMO for CARDS has become more apparent with the progressive development of evidence generated during the pandemic. 7 The 60‐day mortality of patients with severe ARDS on ECMO support has been estimated to be about 35%, 8 not being substantially different in patients with COVID‐19.…”

“…The use of ECMO, particularly in its veno‐venous configuration, is an established practice in different clinical scenarios, particularly as a bridge to lung transplantation. It also represents a viable alternative to intubation in patients developing acute respiratory failure while waiting on the list to receive an organ 4–6 . As outlined in the 2021 updated guidelines from the Extracorporeal Life Support Organization, the role of ECMO for CARDS has become more apparent with the progressive development of evidence generated during the pandemic 7 .…”

Outcomes of Recipients Aged 65 Years and Older Bridged to Lung Transplant With Extracorporeal Membrane Oxygenation

“…[1][2][3] This shift in clinical practice has been facilitated by significant improvements in technology as well as improved understanding of optimal management for patients on ECMO. 1,[4][5][6][7][8] While bridging with ECMO has been associated in some series with complications including longer hospital stay 9,10 and increased usage of blood products, 10 long-term survival has been comparable to recipients without pretransplant support in several studies. 1 The outcomes of ECMO BTT have also improved significantly over time, with outcomes of ECMO BTT shown to be equivalent to those of mechanical ventilation (MV) BTT.…”