Bridge to lung transplantation with extracorporeal membrane oxygenation support

The significant growth in the use of extracorporeal life support (ECLS) devices has been driven by technological advances and new applications. Extracorporeal membrane oxygenation (ECMO) can provide pulmonary and, if needed, right heart support for patients with acute and chronic lung disease. Many patients on lung transplant lists die from acute exacerbations of their underlying chronic lung disease before they can receive a lung transplant. Transplant teams have taken advantage of these recent advances in ECLS to bridge such patients to lung transplantation (bridge to transplant, BTT). We review the recent body of literature in this area and suggest an algorithm for the management of BTT patients.

Although the initial experience and outcomes with ECMO for BTT were unconvincing, recent series demonstrate that good results can be achieved if ECMO protocols and patient selection guidelines are strictly followed. Early mobilization of patients on ECMO for BTT is an important goal because it facilitates participation in physical therapy, encourages oral enteral intake, and improves overall patient conditioning for lung transplantation. Specific cannulation strategies permit early ambulation.

In carefully selected patients, ECMO is a safe and effective means of bridging patients with acute decompensations of their end-stage lung disease to lung transplantation.