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Circulatory support during lung transplantation.

Hannah Kiziltug1, Florian Falter

  • 1Department of Anaesthesia, Royal Papworth Hospital, Papworth Road, Cambridge, UK.

Current Opinion in Anaesthesiology
|November 13, 2019
PubMed
Summary

Extracorporeal membrane oxygenation (ECMO) is increasingly favored over cardiopulmonary bypass (CPB) for lung transplantation, showing promising survival benefits. Further research is needed to confirm optimal mechanical circulatory support (MCS) strategies.

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Area of Science:

  • Cardiovascular Surgery
  • Pulmonary Medicine
  • Transplantation Immunology

Background:

  • Lung transplantation can be performed off-pump, with sequential one-lung ventilation, or using mechanical circulatory support (MCS).
  • Mechanical circulatory support (MCS) includes cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO), either veno-arterial (VA) or veno-venous (VV).

Purpose of the Study:

  • To review the indications, benefits, and limitations of different lung transplantation techniques.
  • To evaluate the effect of these techniques on patient outcomes.

Main Methods:

  • Review of current literature on lung transplantation techniques.
  • Analysis of outcomes associated with off-pump, CPB, and ECMO support.

Main Results:

  • A shift towards intraoperative ECMO support over CPB is observed, with promising initial results.
  • Intraoperative ECMO, especially with postoperative prolongation, shows improved survival compared to lung transplants without ECMO.
  • Encouraging survival rates are reported for recipients of extended criteria donor lungs reperfused with MCS.
  • A meta-analysis indicates favorable outcomes with ECMO versus CPB, though no significant mortality difference was found.

Conclusions:

  • The trend favoring ECMO over CPB in lung transplantation is supported by good survival rates.
  • Randomized controlled trials are needed to guide the optimal choice of MCS strategy for lung transplantation.