Extracorporeal Membrane Oxygenation in Lung Transplantation: Analysis of Techniques and Outcomes

Martin, Archer Kilbourne; Jayaraman, Arun L.; Nabzdyk, Christoph S.; Wilkey, Barbara J.; Fritz, Ashley Virginia; Kolarczyk, Lavinia; Ramakrishna, Harish

doi:10.1053/j.jvca.2020.05.014

Cited by 16 publications

(16 citation statements)

References 53 publications

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“…VV ECMO drains pulmonary vein blood for oxygenation and decarboxylation and returns to the venous circulation. VV ECMO only improves oxygenation compared to VA ECMO ( 3 ), which is why we use VV ECMO. The most common catheter way is the femoral vein and jugular vein, with the tip of the femoral vein located in the inferior vena cava and the tip of the jugular vein located in the superior vena cava ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

Bilateral Lung Transplantation for Congenital Pulmonary Arteriovenous Fistula with Intraoperative Venovenous ECMO Support: The First Case Report in China

et al. 2022

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Pulmonary arteriovenous fistula (PAVF) is a rare pulmonary vascular lesion, more than 80% of which is caused by congenital abnormal development of pulmonary capillaries. The incidence of PAVF ranges from 2/100,000 to 3/100,000, with no difference in the male and female ratio. Congenital PAVF is often associated with hereditary hemorrhagic telangiectasia (HHT). In this article, we report a patient with only congenital PAVF that was successfully treated by bilateral lung transplantation (BLT) with intraoperative venovenous extracorporeal membrane oxygenation (ECMO) support because both lungs have been affected by PAVF and secondary pulmonary hypertension. To the best of our knowledge, this is the first report of BLT for PAVF in China and the second report that explains the clinical course of a patient to receive BLT for congenital PAVF without HHT. Some investigators have proposed lung transplantation as a definitive treatment, but the results are controversial. On the basis of the current condition of this patient, we believe lung transplantation is a viable option for certain patients, but the long-term effect remains to be studied.

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Section: Discussionmentioning

confidence: 99%

Bilateral Lung Transplantation for Congenital Pulmonary Arteriovenous Fistula with Intraoperative Venovenous ECMO Support: The First Case Report in China

et al. 2022

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“…In high-risk patients, pre-induction groin sheath cannulation may be considered, with planned ECLS being VA-ECMO, CPB, or a hybrid VA-ECMO/ CPB circuit to allow for ease of intraoperative conversion (79,80). Once induction is achieved, the use of ECLS may proceed with a variety of configurations, including peripheral or central, depending on preference of the operative team (81). Due to chronic under-filling of the left ventricle, as well as acute remodeling of the right ventricle, recommendations from high performing centers includes the elective postoperative continuation of VA-ECMO (72).…”

Section: Anesthetic Management Of the Patient With Severe Phtnmentioning

confidence: 99%

Anesthetic considerations in lung transplantation: past, present and future

Murray¹,

Boisen²,

Fritz³

et al. 2021

J Thorac Dis

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Lung transplantation is a very complex surgical procedure with many implications for the anesthetic care of these patients. Comprehensive preoperative evaluation is an important component of the transplant evaluation as it informs many of the decisions made perioperatively to manage these complex patients effectively and appropriately. These decisions may involve pre-emptive actions like pre-habilitation and nutrition optimization of these patients before they arrive for their transplant procedure. Appropriate airway and ventilation management of these patients needs to be performed in a manner that provides an optimal operating conditions and protection from ventilatory injury of these fragile post-transplant lungs.Pain management can be challenging and should be managed in a multi-modal fashion with or without the use of an epidural catheter while recognizing the risk of neuraxial technique in patients who will possibly be systemically anticoagulated. Complex monitoring is required for these patients involving both invasive and non-invasive including the use of transesophageal echocardiography (TEE) and continuous cardiac output monitoring. Management of the patient's hemodynamics can be challenging and involves managing the systemic and pulmonary vascular systems. Some patients may require extra-corporeal lung support as a planned part of the procedure or as a rescue technique and centers need to be proficient in instituting and managing this sophisticated method of hemodynamic support.

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“…A postoperative echocardiography service should be designed to be available to evaluate the entire spectrum of lung transplantation that the patient needs, including evaluation of the implanted lung graft, biventricular function, pulmonary anastomoses, and ECMO cannulae [20,[41][42][43][44][45][46].…”

Section: Postoperative Role Of Anesthesiologists In Establishing An Echocardiography Servicementioning

confidence: 99%

“…Another etiology of acute graft dysfunction may lie in the misalignment or malfunction of postoperative ECMO cannulae. The postoperative echocardiography service should be aware of the significant diversity of both VV and VA ECMO cannulae configurations, as rapid assessment of hypoxemia or hemodynamic instability may arise from a variety of ECMO-related complications including recirculation, malposition, or thrombosis-related sequelae [45,46].…”

Section: Postoperative Role Of Anesthesiologists In Establishing An Echocardiography Servicementioning

confidence: 99%

Practical considerations for developing a lung transplantation anesthesiology program

Fritz

Martin

Ramakrishna

2021

Indian J Thorac Cardiovasc Surg

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The advancement in lung transplantation outcomes has been secondary to ongoing improvements within multiple medical specialties. The recent emergence of literature describing the impact of anesthetic management on perioperative outcomes has led to the beginnings of formalized training fellowships within lung transplantation anesthesiology. Practical considerations for the development of a lung transplantation anesthesiology program, both clinical and educational, are herein described.

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Extracorporeal Membrane Oxygenation in Lung Transplantation: Analysis of Techniques and Outcomes

Cited by 16 publications

References 53 publications

Bilateral Lung Transplantation for Congenital Pulmonary Arteriovenous Fistula with Intraoperative Venovenous ECMO Support: The First Case Report in China

Bilateral Lung Transplantation for Congenital Pulmonary Arteriovenous Fistula with Intraoperative Venovenous ECMO Support: The First Case Report in China

Anesthetic considerations in lung transplantation: past, present and future

Practical considerations for developing a lung transplantation anesthesiology program

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