Extracorporeal Membrane Oxygenation in Lung Transplantation: Analysis of Techniques and Outcomes

Abstract

EXTRACORPOREAL MEMBRANE oxygenation (ECMO) was first used in the perioperative care of a lung transplantation patient in 1975, a mere 3 years after initial introduction into clinical use. 1 Gulack B.C. Hirji S.A. Hartwig M.G. Bridge to lung transplantation and rescue post-transplant: The expanding role of extracorporeal membrane oxygenation. J Thorac Dis. 2014; 6: 1070-1079 PubMed Google Scholar As ECMO technology progressed, indications for its clinical use expanded significantly within the end-stage lung disease (ESLD) population. Within the lung transplantation population, ECMO is now used across the entire spectrum of perioperative management, including bridge to transplant (BTT) and intraoperative and postoperative support. 1 Gulack B.C. Hirji S.A. Hartwig M.G. Bridge to lung transplantation and rescue post-transplant: The expanding role of extracorporeal membrane oxygenation. J Thorac Dis. 2014; 6: 1070-1079 PubMed Google Scholar ,2 Hoetzenecker K. Schwarz S. Muckenhuber M. et al. Intraoperative extracorporeal membrane oxygenation and the possibility of postoperative prolongation improve survival in bilateral lung transplantation. J Thorac Cardiovasc Surg. 2018; 155 (2193-206.e3) Abstract Full Text Full Text PDF Scopus (118) Google Scholar Lung transplantation teams, comprised of multidisciplinary specialists, require a common knowledge and coordinated effort to achieve optimal outcomes for patients with ESLD. 3 Martin A.K. Yalamuri S.M. Wilkey B.J. et al. The impact of anesthetic management on perioperative outcomes in lung transplantation. J Cardiothorac Vasc Anesth. 2020; 34: 1669-1680 Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar ,4 Wilkey B.J. Abrams B.A. Del Rio J.M. et al. Statement from the Society for the Advancement of Transplant Anesthesia: White paper advocating desirable milestones and competencies for anesthesiology fellowship training in the field of lung transplantation. Semin Cardiothorac Vasc Anesth. 2020; 24: 104-114 Crossref PubMed Scopus (8) Google Scholar This paper aims to analyze study results pertaining to ECMO techniques and outcomes from the past decade and includes a discussion regarding indications for ECMO use, cannulation techniques, and outcomes data throughout the perioperative period.