Mechanical circulatory support in lung transplantation: Cardiopulmonary bypass, extracorporeal life support, and ex-vivo lung perfusion

Table 1 Comparison of mechanical circulatory support modalities

	Open/closed	Pump	Cannulation	Indications	Phase of transplant
CPB	Open	Yes (Centrifugal or Roller)	Central (intrathoracic)	Hemodynamic instability	Intraoperative
				Pulmonary hypertension
				Right ventricular failure
				En bloc double-LTx
ECLS/iLA	Closed	No (Pump may be added)	Usually peripheral (also PA-LA)	Refractory:	Bridge to Tx (Awake)
				Hypercarbia (PCO2 > 80 mmHg)
VV-ECMO	Closed	Yes (Centrifugal or Roller)	Peripheral (BCDLC)	Refractory:	Bridge to Tx (Awake)
				Hypoxia (PaO2:FiO2 < 80 mmHg)	Graft Salvage
				Hypercarbia PCO2 > 80 mmHg
VA-ECMO	Closed	Yes (Centrifugal or Roller)	Peripheral (sometimes Central)	Hemodynamic instability	Bridge to Tx
				Pulmonary hypertension	Intraoperative
				Right heart failure	Graft Salvage

CPB: Cardiopulmonary bypass; ECLS: Extracorporeal lung support; iLA: Interventional lung assist; VV: Venovenous; VA: Venoarterial; ECMO: Extracorporeal membrane oxygenation; PA-LA: Pulmonary artery-left atrium; BCDLC: Bi-caval dual lumen cannula.