Right ventricular mechanical support as a bridge to lung transplantation: A literature review of current practices

Extracorporeal life support (ECLS) serves as a bridge to lung transplantation (BTT) for patients with acute respiratory failure (ARF) or right ventricular (RV) dysfunction/failure (RVD/RVF). Proper assessment and management of RV function in BTT patients are crucial for successful outcomes. However, there is a lack of consensus on standardized RV assessment strategies or optimal ECLS configurations. We aim to synthesize current evidence on RVD/RVF assessment and management in BTT patients requiring ECLS, providing a foundation to aid development of standardized clinical algorithms. A scoping literature search across PubMed, Embase, Web of Science, Cochrane Library, and grey literature was performed. Inclusion criteria comprised human studies reporting on RV assessment and/or management in BTT patients. Data on patient characteristics, RV assessment methods, and ECLS strategies were extracted. A total of 280 patients were identified. Acute respiratory failure (ARF) was the most common BTT indication (40.4%), followed by RVF (33.2%) and RVD (17.9%). Echocardiography (52.5%) and right heart catheterization (43.2%) were the primary RV assessment tools. However, reporting of specific parameters of RV assessment was inconsistent. Furthermore, we report important variability of practice in ECLS strategies: VV-ECMO (38.8%) was the most common ECLS strategy, followed by VA-ECMO (31.1%), VAV-ECMO (8.2%), and OxyRVAD (13.2%). Based on our findings, bridging strategies currently lack guidance. As BTT is often confronted with dynamic changes over time, respiratory and circulatory ECLS indications may be overlapping. Therefore, a personalized patient approach is needed. We recommend implementing institutional guidelines and international standards to systematically capture this practice.