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Published on: August 15, 2022
Extracorporeal membrane oxygenation post lung transplantation
Anthony W Castleberry1, Matthew G Hartwig, Bryan A Whitson
1aDepartment of Surgery bDivision of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina cDivision of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Current Opinion in Organ Transplantation
|September 3, 2013
Summary
Extracorporeal membrane oxygenation (ECMO) effectively supports failing lung transplants when initiated early. Advances in ECMO technology and management strategies improve outcomes for lung allograft recipients.
Area of Science:
- Cardiovascular and Respiratory Medicine
- Transplantation Immunology
Background:
- Lung transplantation is a critical treatment for end-stage lung disease.
- Pulmonary allograft failure can occur post-transplantation, necessitating advanced support.
- Extracorporeal membrane oxygenation (ECMO) is a potential life-saving intervention.
Purpose of the Study:
- To review the indications for ECMO in post-lung transplant patients.
- To discuss technical considerations and management strategies for ECMO use.
- To evaluate the outcomes of ECMO in supporting failing pulmonary allografts.
Main Methods:
- Review of current literature on ECMO use after lung transplantation.
- Analysis of indications, cannulation techniques, and management protocols.
- Assessment of reported patient outcomes, including survival rates.
Main Results:
- ECMO is indicated for early allograft failure unresponsive to conventional support.
- Early ECMO initiation (e.g., <48h) may reduce ventilator-induced injury.
- Veno-venous ECMO and dual-stage cannulation offer benefits in complication reduction and mobility.
- Effective management includes minimal sedation, controlled ventilation, and cautious anticoagulation (e.g., bivalirudin).
- Successful wean rates up to 96% and significant short-term survival (82% at 30 days) are reported.
Conclusions:
- ECMO is an increasingly effective strategy for managing post-lung transplant allograft failure.
- Technological and managerial advancements enhance ECMO's role in supporting lung allografts.
- Optimized ECMO protocols contribute to improved survival post-lung transplantation.
