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.

Keywords: Lung transplantation; Extracorporeal membrane oxygenation; Bridge to transplantation; Support; Primary graft dysfunction; Ischemia-reperfusion injury

Core Tip: Extracorporeal membrane oxygenation (ECMO) is the most used support in lung transplantation as it allows a complete spectrum of support (blood oxygenation, decarboxylation and cardiocirculatory support). Due to its versatility it can be used in a pre-operative setting (bridge to transplantation) and might be prolonged intra- and/or post-operatively. All these factors, in combination with a growing experience in its use in lung transplantation, usually in a multidisciplinary team, has resulted in good outcomes derived from several experiences reported in the literature by high-volume transplant centers. This paper aims to systematically review current evidence on pre, intra and post-operative ECMO in lung transplantation.