Extracorporeal life support in lung transplantation with dual-lumen cannulas: A systematic review

BackgroundRefractory end-stage lung failure may benefit from extracorporeal life support (ECLS) as a bridge to lung transplantation. Venovenous (VV) extracorporeal membrane oxygenation (ECMO) is indicated in patients who have failed conventional medical treatment and mechanical ventilation. The Avalon Elite Bi-Caval Dual-Lumen Catheter (Getinge) and the Crescent Jugular Dual-Lumen Catheter (MC3, Inc., Medtronic) have been used for this configuration. Venoarterial (VA) ECMO may be used in patients with acute right ventricular (RV) failure, haemodynamic instability or refractory respiratory failure. Peripheral percutaneous approaches such as dual-site single-lumen cannulation for venopulmonary (VP) ECMO or single-site dual-lumen (dl)VP ECMO using the ProtekDuo right ventricular assist device (RVAD) cannula have been considered more recently as a bridge to transplant. These configurations support the right ventricle, prevent recirculation by placing the tricuspid and pulmonary valve between drainage and return cannulas, provide direct introduction of oxygenated blood into the pulmonary artery, and decrease the incidence of acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) in certain disease states. This promotes haemodynamic stability and allows sedation-weaning trials, extubation, mobilisation, and pre-transplant rehabilitation. The aim of this review is the evaluation of the feasibility, outcomes and reported complications associated with dual-lumen cannulas - specifically the Avalon Elite, Crescent and ProtekDuo - used for VV and VP ECMO in adult patients requiring bridge to lung transplantation.MethodsA web-based literature search in PubMed and EMBASE was undertaken following a combination of key words. The PICOS and PRISMA approach was used.ResultsNine studies were identified out of 489 articles with a total of 251 patients placed on VV or VP ECMO as a bridge to lung transplantation. The age range was 23-68 years. The duration of ECMO support ranged from 42 h to 200 days. About 60% of patients were awake and underwent mobilisation. Survival to lung transplantation ranged from 25% to 100%. All relevant data were reviewed and integrated in the discussion.ConclusionsSingle-site dual-lumen cannulation has an established role in VV ECMO bridging strategies and an emerging role in VP ECMO for patients with RV injury. Broader adoption of VP ECMO as a bridging strategy will require rigorous reporting and inclusion into multicentre registries to generate high-level evidence.