Management of primary graft dysfunction after lung transplantation with extracorporeal life support: an evidence-based review

Luu, Hubert Y.; Santos, Jesse; Isaza, Erin; Brzeziński, Marek; Kukreja, Jasleen

doi:10.21037/jtd-22-1387

Cited by 5 publications

(1 citation statement)

References 63 publications

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“…LTx patients supported by ECMO had poor lung function and 6MWT results. ECMO was used continuously during and after LTx to improve the hemodynamic state, facilitate gas exchange and provide support for the acute phase of severe PGD 12 . The present investigation suggests that ECMO type was not a risk factor for PMV and that appropriate use of V–V ECMO and V–A ECMO did not affect ventilation time in general.…”

Section: Discussionmentioning

confidence: 99%

A novel nomogram for predicting prolonged mechanical ventilation in lung transplantation patients using extracorporeal membrane oxygenation

Xuan,

Gu,

et al. 2024

Sci Rep

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Prolonged mechanical ventilation (PMV) is commonly associated with increased post-operative complications and mortality. Nevertheless, the predictive factors of PMV after lung transplantation (LTx) using extracorporeal membrane oxygenation (ECMO) as a bridge remain unclear. The present study aimed to develop a novel nomogram for PMV prediction in patients using ECMO as a bridge to LTx. A total of 173 patients who used ECMO as a bridge following LTx from January 2022 to June 2023 were divided into the training (122) and validation sets (52). A mechanical ventilation density plot of patients after LTx was then performed. The training set was divided in two groups, namely PMV (95) and non-prolonged ventilation (NPMV) (27). For the survival analysis, the effect of PMV was assessed using the log-rank test. Univariate and multivariate logistic regression analyses were performed to assess factors associated with PMV. A risk nomogram was established based on the multivariate analysis, and model performance was further assessed in terms of calibration, discrimination, and clinical usefulness. Internal validation was additionally conducted. The difference in survival curves in PMV and NPMV groups was statistically significant (P < 0.001). The multivariate analysis and risk factors in the nomogram revealed four factors to be significantly associated with PMV, namely the body mass index (BMI), operation time, lactic acid at T0 (Lac), and driving pressure (DP) at T0. These four factors were used to develop a nomogram, with an area under the curve (AUC) of 0.852 and good calibration. After internal validation, AUC was 0.789 with good calibration. Furthermore, goodness-of-fit test and decision-curve analysis (DCA) indicated satisfactory performance in the training and internal validation sets. The proposed nomogram can reliably and accurately predict the risk of patients to develop PMV after LTx using ECMO as a bridge. Four modifiable factors including BMI, operation time, Lac, and DP were optimized, which may guide preventative measures and improve prognosis.

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Section: Discussionmentioning

confidence: 99%

A novel nomogram for predicting prolonged mechanical ventilation in lung transplantation patients using extracorporeal membrane oxygenation

Xuan,

Gu,

et al. 2024

Sci Rep

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Current status of routine use of veno-arterial extracorporeal membrane oxygenation during lung transplantation

Hauser,

Estafanos,

Ayyat

et al. 2024

Expert Review of Medical Devices

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The role of extracorporeal membrane oxygenation in thoracic anesthesia

Tschernko,

Geilen,

Wasserscheid

2024

Current Opinion in Anaesthesiology

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Purpose of review Circulatory and respiratory support with extracorporeal membrane oxygenation (ECMO) has gained widespread acceptance during high-end thoracic surgery. The purpose of this review is to summarize the recent knowledge and give an outlook for future developments. Recent findings A personalized approach of ECMO use is state of the art for monitoring during surgery. Personalization is increasingly applied during anesthesia for high-end surgery nowadays. This is reflected in the point of care testing (POCT) for anticoagulation and cardiac function during surgery on ECMO combining specific patient data into tailored algorithms. For optimizing protective ventilation MP (mechanical power) is a promising parameter for the future. These personalized methods incorporating numerous patient data are promising for the improvement of morbidity and mortality in high-end thoracic surgery. However, clinical data supporting improvement are not available to date but can be awaited in the future. Summary Clinical practice during surgery on ECMO is increasingly personalized. The effect of personalization on morbidity and mortality must be examined in the future. Undoubtedly, an increase in knowledge can be expected from this trend towards personalization.

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Management of primary graft dysfunction after lung transplantation with extracorporeal life support: an evidence-based review

Cited by 5 publications

References 63 publications

A novel nomogram for predicting prolonged mechanical ventilation in lung transplantation patients using extracorporeal membrane oxygenation

A novel nomogram for predicting prolonged mechanical ventilation in lung transplantation patients using extracorporeal membrane oxygenation

Current status of routine use of veno-arterial extracorporeal membrane oxygenation during lung transplantation

The role of extracorporeal membrane oxygenation in thoracic anesthesia

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