Extracorporeal membrane oxygenation in lung transplantation: Indications, techniques and results

Abstract

The use of extracorporeal membrane oxygenation (ECMO) in the field of lung transplantation has rapidly expanded over the past 30 years. It has become an important tool in an increasing number of specialized centers as a bridge to transplantation and in the intra-operative and/or post-operative setting. ECMO is an extremely versatile tool in the field of lung transplantation as it can be used and adapted in different configurations with several potential cannulation sites according to the specific need of the recipient. For example, patients who need to be bridged to lung transplantation often have hypercapnic respiratory failure that may preferably benefit from veno-venous (VV) ECMO or peripheral veno-arterial (VA) ECMO in the case of hemodynamic instability. Moreover, in an intra-operative setting, VV ECMO can be maintained or switched to a VA ECMO. The routine use of intra-operative ECMO and its eventual prolongation in the post-operative period has been widely investigated in recent years by several important lung transplantation centers in order to assess the graft function and its potential protective role on primary graft dysfunction and on ischemia-reperfusion injury. This review will assess the current evidence on the role of ECMO in the different phases of lung transplantation, while analyzing different studies on pre, intra- and post-operative utilization of this extracorporeal support.

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).…”

Intraoperative Circulatory Support in Lung Transplantation: Current Trend and Its Evidence

“…In addition, a central ECMO must be surgically removed and complicates mobilisation in the ICU. These drawbacks can be avoided by inserting a VVA ECMO or connecting the arterial cannula to the subclavian artery using a prothesis [ 3 , 5 , 7 ].…”

“…A major change in intraoperative management was the use of extracorporeal membrane oxygenation (ECMO) as a closed system as compared to the cardiopulmonary bypass (CPB). With different cannulation strategies (veno-arterial and veno-venous (VA ECMO and VV ECMO), as well as central and peripheral cannulation), it became possible to support both oxygenation and, if needed, circulation with minimal anticoagulation and with reduced invasiveness [ 7 ]. Regarding the application of this procedure, different strategies exist depending on the respective transplant centre.…”

The role of extracorporeal membrane oxygenation in thoracic surgery—a narrative review

“…This is guided by haemodynamic status and graft function. A new ECMO circuit can also be initiated in the post-operative period to manage haemodynamic instability, primary graft dysfunction or reperfusion injury (64). Patients requiring VA-ECMO support into the post-operative period have a higher mortality rate when comparted to VV-ECMO (2).…”