Lung transplantation on cardiopulmonary support: Venoarterial extracorporeal membrane oxygenation outperformed cardiopulmonary bypass

Ius, F.; Kuehn, C.; Tudorache, I.; Sommer, W.; Avşar, M.; Boethig, Dietmar; Fuehner, Thomas; Gottlieb, Jens; Hoeper, Marius M.; Haverich, Axel; Warnecke, G.

doi:10.1016/j.jtcvs.2012.07.095

Cited by 188 publications

(147 citation statements)

References 25 publications

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“…Until recently, cardiopulmonary bypass (CPB) had been the standard method [49]. However, it is associated with an increased peri-and post-procedural risk of bleeding due to heparinisation, as well as an increased risk of primary graft dysfunction resulting from the systemic inflammatory response [49].…”

Section: Peri-lung Transplantationmentioning

confidence: 99%

Advanced pulmonary arterial hypertension: mechanical support and lung transplantation

2017

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The development of targeted therapies has transformed the outlook for patients with pulmonary arterial hypertension (PAH); however, some patients fail to achieve an adequate clinical response despite receiving maximal treatment. For these patients, lung transplantation remains an important therapeutic option, and recommendations for transplantation are included in the current European Society of Cardiology/European Respiratory Society guidelines for the diagnosis and treatment of pulmonary hypertension. Although lung transplantation is not without risk, overall long-term survival rates are good and substantial improvements in quality of life have been reported for lung transplant recipients. In this review, we describe the important considerations prior to, during and after transplantation, including the role of mechanical support, in patients with advanced PAH.

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Section: Peri-lung Transplantationmentioning

confidence: 99%

Advanced pulmonary arterial hypertension: mechanical support and lung transplantation

2017

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“…Comparing the CPB, VA ECMO would allow to decrease the requirement for dialysis, the risk of bleeding, the need of blood products transfusions, the rates of PGD, and the ICU and hospital lengths of stay (24)(25)(26).…”

Section: Ecls As An Intraoperative Supportmentioning

confidence: 99%

Vascular access for extracorporeal life support: tips and tricks

et al. 2016

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In thoracic surgery, extracorporeal life support (ECLS) techniques are performed to (I) provide a short to mid term extracorporeal mechanical support; (II) realize the gas exchanges; and (III)-depending the configuration of the circuit-substitute the failed heart function. The objective of this review is to describe the rational of the different ECLS techniques used in thoracic surgery and lung transplantation (LTx) with a specific attention to the vascular access. Venovenous extracorporeal membrane oxygenation (VV ECMO)is the most common ECLS technique used in thoracic surgery and represents the best strategy to support the lung function. VV ECMO needs peripheral vascular access. The selection between his double-site or single-site configuration should be decided according the level of O 2 requirements, the nosological context, and the interest to perform an ECLS ambulatory strategy. Venoarterial (VA) ECMO uses peripheral and/or central cannulation sites. Central VA ECMO is mainly used in LTx instead a conventional cardiopulmonary bypass (CPB) to decrease the risk of hemorrhagic issues and the rate of primary graft dysfunction (PGD).Peripheral VA ECMO is traditionally realized in a femoro-femoral configuration. Femoro-femoral VA ECMO allows a cardiocirculatory support but does not provide an appropriate oxygenation of the brain and the heart. The isolated hypercapnic failure is currently supported by extracorporeal CO 2 removal (ECCO 2 R) devices inserted in jugular or subclavian veins. The interest of the Novalung (Novalung GmbH, Hechingen, Germany) persists due to his central configuration indicated to bridge to LTx patients suffering from pulmonary hypertension. The increasing panel of ECLS technologies available in thoracic surgery is the results of a century of clinical practices, engineering progress, and improvements of physiological knowledges. The selection of the ECLS technique-and therefore the vascular access to implant the device-for a given nosological context trends to be defined according an evidence-based medicine.

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“…ECMO is associated with lower heparin dose and reduced blood-activating surface due to lack of a venous reservoir and additional suction lines (3), thus attenuating coagulopathy and inflammatory cascade related to CPB. Furthermore, ECMO could be easily extended to postoperative care in case of postoperative graft dysfunction (3). Recently, some centers in Europe and North America changed their primary modality of intraoperative cardiopulmonary support from CPB to ECMO and reported the potential advantages of ECMO (3)(4)(5)(6)(7).…”

Section: Original Articlementioning

confidence: 99%

“…Furthermore, ECMO could be easily extended to postoperative care in case of postoperative graft dysfunction (3). Recently, some centers in Europe and North America changed their primary modality of intraoperative cardiopulmonary support from CPB to ECMO and reported the potential advantages of ECMO (3)(4)(5)(6)(7). These reports showed that improved short-term outcomes such as less bleeding and reoperation, less perioperative requirement for transfusion, fewer respiratory and renal complications, shorter mechanical ventilation (MV) duration, shorter intensive care unit (ICU) and hospital stay, and better short-term survival compared with CPB.…”

Section: Original Articlementioning

confidence: 99%

“…Postoperative bleeding is defined as reoperation for bleeding or transfusion of more than 6 units of pRBC up to 48 hours after LTx (6). Rejection is defined as the need for at least 1 steroid pulse therapy in the presence of unexplained worsening of lung function and gas exchange and an increase in inflammatory parameters (3). Neurologic complication included cerebral infarction, intracranial hemorrhage, and/or seizure.…”

Section: Data Collectionmentioning

confidence: 99%

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Transition to routine use of venoarterial extracorporeal oxygenation during lung transplantation could improve early outcomes

Paik

Haam

et al. 2016

J. Thorac. Dis.

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Lung transplantation on cardiopulmonary support: Venoarterial extracorporeal membrane oxygenation outperformed cardiopulmonary bypass

Abstract: Intraoperative ECMO allows for better periprocedural management and reduced postoperative complications and confers a survival benefit compared with CPB, mainly because of lower in-hospital mortality. It is now the standard of care in our lung transplantation program.

Cited by 188 publications

References 25 publications

Advanced pulmonary arterial hypertension: mechanical support and lung transplantation

Advanced pulmonary arterial hypertension: mechanical support and lung transplantation

Vascular access for extracorporeal life support: tips and tricks

Transition to routine use of venoarterial extracorporeal oxygenation during lung transplantation could improve early outcomes

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