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Usman AA, Spelde AE, Lutfi W, Gutsche JT, Vernick WJ, Toubat O, Olia SE, Cantu E, Courtwright A, Crespo MM, Diamond J, Biscotti M, Bermudez CA. Percutaneous Venopulmonary Extracorporeal Membrane Oxygenation as Bridge to Lung Transplantation. ASAIO J 2024; 70:758-766. [PMID: 38446842 PMCID: PMC11365796 DOI: 10.1097/mat.0000000000002179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
Mechanical circulatory support (MCS) as a bridge to lung transplant is an infrequent but accepted pathway in patients who have refractory end-stage pulmonary failure. The American Association of Thoracic Surgeons Expert Consensus Guidelines, published in 2023, recommends venovenous (VV) extracorporeal membrane oxygenation (ECMO) as the initial configuration for those patients who have failed conventional medical therapy, including mechanical ventilation, while waiting for lung transplantation and needing MCS. Alternatively, venoarterial (VA) ECMO can be used in patients with acute right ventricular failure, hemodynamic instability, or refractory respiratory failure. With the advancement in percutaneous venopulmonary (VP) ECMO cannulation techniques, this option is becoming an attractive configuration as bridge to lung transplantation. This configuration enhances stability of the right ventricle, prevents recirculation with direct introduction of pulmonary artery oxygenation, and promotes hemodynamic stability during mobility, rehabilitation, and sedation-weaning trials before lung transplantation. Here, we present a case series of eight percutaneous VP ECMO as bridge to lung transplant with all patients mobilized, awake, and successfully transplanted with survival to hospital discharge.
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Affiliation(s)
- Asad Ali Usman
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Audrey Elizabeth Spelde
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Wasim Lutfi
- Department of Surgery, Division of Cardiothoracic Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - William J. Vernick
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Omar Toubat
- Department of Surgery, Division of Cardiothoracic Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Salim E. Olia
- Department of Surgery, Division of Cardiothoracic Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Edward Cantu
- Department of Surgery, Division of Cardiothoracic Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Andrew Courtwright
- Department of Medicine, Division of Pulmonary Medicine, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Maria M Crespo
- Department of Medicine, Division of Pulmonary Medicine, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Joshua Diamond
- Department of Medicine, Division of Pulmonary Medicine, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Mauer Biscotti
- Department of Surgery, Division of Cardiothoracic Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Christian A. Bermudez
- Department of Surgery, Division of Cardiothoracic Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA
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Capoccia M, Brewer JM, Rackauskas M, Becker TK, Maybauer DM, Stukov Y, Lorusso R, Maybauer MO. Outcome of Veno-Pulmonary Extracorporeal Life Support in Lung Transplantation Using ProtekDuo Cannula: A Systematic Review and Description of Configurations. J Clin Med 2024; 13:4111. [PMID: 39064150 PMCID: PMC11277848 DOI: 10.3390/jcm13144111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 06/29/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Refractory end-stage pulmonary failure may benefit from extracorporeal life support (ECLS) as a bridge to lung transplantation. Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) has been recommended for patients who have failed conventional medical therapy and mechanical ventilation. Veno-arterial (VA) ECMO may be used in patients with acute right ventricular (RV) failure, haemodynamic instability, or refractory respiratory failure. Peripheral percutaneous approaches, either dual-site single-lumen cannulation for veno-pulmonary (VP) ECMO or single-site dual-lumen (dl)VP ECMO, using the ProtekDuo right ventricular assist device (RVAD) cannula, has made this configuration a desirable option as a bridge to transplantation. These configurations support the right ventricle, prevent recirculation by placing the tricuspid and pulmonary valve between the drainage and return cannulas, provide the direct introduction of oxygenated blood into the pulmonary artery, and have been shown to decrease the incidence of acute kidney injury (AKI), requiring continuous renal replacement therapy (CRRT) in certain disease states. This promotes haemodynamic stability, potential sedation-weaning trials, extubation, mobilisation, and pre-transplant rehabilitation. Methods: A web-based literature search in PubMed and EMBASE was undertaken based on a combination of keywords. The PICOS and PRISMA approaches were used. Results: Four case series were identified out of 323 articles, with a total of 34 patients placed on VP ECMO as a bridge to lung transplantation. All relevant data are reviewed and integrated into the Discussion. Conclusions: Despite the limited available evidence, the use of ProtekDuo has become very promising for the management of end-stage lung disease as a bridge to lung transplantation.
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Affiliation(s)
- Massimo Capoccia
- South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK
| | - Joseph M. Brewer
- Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support Service, INTEGRIS Baptist Medical Center, Oklahoma City, OK 73112, USA;
- Queen’s University Health Quality Programs, Kingston, ON K7L 3N6, Canada
| | - Mindaugas Rackauskas
- Department of Surgery, Division of Thoracic Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA; (M.R.); (Y.S.)
| | - Torben K. Becker
- Department of Emergency Medicine, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA;
| | - Dirk M. Maybauer
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, 35032 Marburg, Germany;
| | - Yuriy Stukov
- Department of Surgery, Division of Thoracic Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA; (M.R.); (Y.S.)
| | - Roberto Lorusso
- Extracorporeal Life Support (ECLS) Centrum, Cardio-Thoracic Surgery and Cardiology Department, Heart & Vascular Center, Maastricht University Medical Center (MUMC), 6229 ER Maastricht, The Netherlands;
- Cardiovascular Research Institute (CARIM), 6229 ER Maastricht, The Netherlands
| | - Marc O. Maybauer
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, 35032 Marburg, Germany;
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane 4032, Australia
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Stącel T, Kegler K, Mędrala A, Sybila P, Ochman M, Nęcki M, Pasek P, Gummenyi I, Pióro A, Przybyłowski P, Hrapkowicz T, Urlik M. Lung Transplantation in Patients With Pulmonary Hypertension With Extracorporeal Membrane Oxygenation (ECMO) Support: 5-Year Experience. Transplant Proc 2024; 56:898-903. [PMID: 38580513 DOI: 10.1016/j.transproceed.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/19/2024] [Accepted: 02/29/2024] [Indexed: 04/07/2024]
Abstract
Lung transplantation (LTx) is the only treatment option of patients (pts) with pulmo-nary hypertension (PH) when pharmacologic treatment is unsatisfactory. ECMO is essential during LTx in every patient with pulmonary arterial hypertension and in most patients with sec-ondary PH. This is a retrospective, single-center study comparing LTx outcomes in patients with and without PH covering a 5-year experience. In the years 2018-2023, 219 LTx were performed, of which 56 (25.6%) with ECMO support, among which PH was diagnosed in 34pts (60.7%) in WHO groups 1,3,4: 19pts, 14pts. and 1pt respectively. The veno-arterial type of ECMO was used in patients with PH as intraoperative support (n = 34; 100%). The early (30-day) and long-term survival (1 year) of patients with and without PH did not differ statistically: 91.2% (95% CI: 82.1%-100%) vs. 77.3% (95% CI: 82.1%-100%)(P = .48) and 53.0% (95% CI: 36.6%-76.7 %) vs. 41.3% (95%CI: 23.1-74.0) (P = .48) respectively and the median hospitalization time from ECMO weaning to dis-charge was also comparable: 31 days (Q1-Q3: 21-40; IQR 20) vs. 28 days (Q1-Q3: 24-42; IQR :18) (P = .99). Patients with or without PH undergoing LTx with ECMO have comparable survival and hospital stay outcomes despite being the most challenging of all lung diseases treated with lung transplantation.
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Affiliation(s)
- Tomasz Stącel
- Department of Cardiac, Silesian Centre for Heart Diseases in Zabrze, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
| | - Kamil Kegler
- Department of Cardiac, Silesian Centre for Heart Diseases in Zabrze, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland.
| | - Agata Mędrala
- Department of Cardiac, Silesian Centre for Heart Diseases in Zabrze, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
| | - Pawel Sybila
- Department of Cardiac, Silesian Centre for Heart Diseases in Zabrze, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
| | - Marek Ochman
- Department of Cardiac, Silesian Centre for Heart Diseases in Zabrze, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
| | - Mirosłąw Nęcki
- Department of Cardiac, Silesian Centre for Heart Diseases in Zabrze, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
| | - Piotr Pasek
- Department of Cardiac, Silesian Centre for Heart Diseases in Zabrze, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
| | - Igor Gummenyi
- Department of Cardiac, Silesian Centre for Heart Diseases in Zabrze, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
| | - Anna Pióro
- Department of Cardiac Anaesthesia and Intensive Care, Silesian Centre for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Piotr Przybyłowski
- Department of Cardiac, Silesian Centre for Heart Diseases in Zabrze, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
| | - Tomasz Hrapkowicz
- Department of Cardiac, Silesian Centre for Heart Diseases in Zabrze, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
| | - Maciej Urlik
- Department of Cardiac, Silesian Centre for Heart Diseases in Zabrze, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
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Yang J, Xie X, Li J, Li Y, Li B, Wang C, Jiang P. Which strategy is better for lung transplantation: Cardiopulmonary bypass or extracorporeal membrane oxygenation? Perfusion 2024:2676591241242018. [PMID: 38557237 DOI: 10.1177/02676591241242018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background: In lung transplantation surgery, extracorporeal life support (ECLS) is essential for safety. Various support methods, including cardiopulmonary bypass (CPB) and off-pump techniques, are used, with extracorporeal membrane oxygenation (ECMO) gaining prominence. However, consensus on the best support strategy is lacking.Purpose: This article reviews risks, benefits, and outcomes of different support strategies in lung transplantation. By consolidating knowledge, it aims to clarify selecting the most appropriate ECLS modality.Research Design: A comprehensive literature review examined CPB, off-pump techniques, and ECMO outcomes in lung transplantation, including surgical results and complications.Study Sample: Studies, including clinical trials and observational research, focused on ECLS in lung transplantation, both retrospective and prospective, providing a broad evidence base.Data Collection and/or Analysis: Selected studies were analyzed for surgical outcomes, complications, and survival rates associated with CPB, off-pump techniques, and ECMO to assess safety and effectiveness.Results: Off-pump techniques are preferred, with ECMO increasingly vital as a bridge to transplant, overshadowing CPB. However, ECMO entails hidden risks and higher costs. While safer than CPB, optimizing ECMO postoperative use and monitoring is crucial for success.Conclusions: Off-pump techniques are standard, but ECMO's role is expanding. Despite advantages, careful ECMO management is crucial due to hidden risks and costs. Future research should focus on refining ECMO use and monitoring to improve outcomes, emphasizing individualized approaches for LT recipients.
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Affiliation(s)
- Jianbao Yang
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xinling Xie
- Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Jian Li
- Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Yongnan Li
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Bin Li
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Cheng Wang
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Peng Jiang
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China
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Hang D, Chandrashekarappa K, Schilling K, Ubert A, de Oliveira N, Pagel PS. A two-circuit strategy for intraoperative extracorporeal support during single lung transplantation in a patient bridged with venovenous extracorporeal membrane oxygenation. Perfusion 2024; 39:281-284. [PMID: 36301682 DOI: 10.1177/02676591221137471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Venovenous extracorporeal membrane oxygenation is increasingly used as a bridging strategy in decompensating patients awaiting lung transplantation. Various approaches for continuing support intraoperatively have been previously described. A two-circuit strategy that uses the in situ venovenous extracorporeal membrane oxygenation circuit supplemented with peripheral cardiopulmonary bypass allows for diversion of native cardiac output away from the transplanted lung as well as seamless continuation of venovenous extracorporeal membrane oxygenation postoperatively.
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Affiliation(s)
- Dustin Hang
- Medical College of Wisconsin Department of Anesthesiology, Milwaukee, WI, USA
| | | | - Kyle Schilling
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Adam Ubert
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nilto de Oliveira
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paul S Pagel
- Anesthesiology, Clement J Zablocki VA Medical Center, Milwaukee, WI, USA
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Ukita R, Patel YJ, Kelly Wu W, Francois SA, Cortelli M, Johnson CA, Cardwell N, Talackine JR, Stokes JW, Grogan W, Mentz M, Tracy KM, Harris TR, Tucker W, Simonds E, Demarest CT, Cook KE, Skoog DJ, Rosenzweig EB, Bacchetta M. Ambulatory 7-day mechanical circulatory support in sheep model of pulmonary hypertension and right heart failure. J Heart Lung Transplant 2024; 43:293-302. [PMID: 37907183 PMCID: PMC10842834 DOI: 10.1016/j.healun.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 10/11/2023] [Accepted: 10/22/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Right heart failure is the major cause of death in pulmonary hypertension. Lung transplantation is the only long-term treatment option for patients who fail medical therapy. Due to the scarcity of donor lungs, there is a critical need to develop durable mechanical support for the failing right heart. A major design goal for durable support is to reduce the size and complexity of devices to facilitate ambulation. Toward this end, we sought to deploy wearable mechanical support technology in a sheep disease model of chronic right heart failure. METHODS In 6 sheep with chronic right heart failure, a mechanical support system consisting of an extracorporeal blood pump coupled with a gas exchange unit was attached in a right atrium-to-left atrium configuration for up to 7 days. Circuit performance, hematologic parameters, and animal hemodynamics were analyzed. RESULTS Six subjects underwent the chronic disease model for 56 to 71 days. Three of the subjects survived to the 7-day end-point for circulatory support. The circuit provided 2.8 (0.5) liter/min of flow compared to the native pulmonary blood flow of 3.5 (1.1) liter/min. The animals maintained physiologically balanced blood gas profile with a sweep flow of 1.2 (1.0) liter/min. Two animals freely ambulated while wearing the circuit. CONCLUSIONS Our novel mechanical support system provided physiologic support for a large animal model of pulmonary hypertension with right heart failure. The small footprint of the circuit and the low sweep requirement demonstrate the feasibility of this technology to enable mobile ambulatory applications.
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Affiliation(s)
- Rei Ukita
- Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN, USA
| | - Yatrik J Patel
- Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN, USA
| | - W Kelly Wu
- Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN, USA
| | - Sean A Francois
- Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN, USA
| | - Michael Cortelli
- Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN, USA
| | - Carl A Johnson
- Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN, USA
| | - Nancy Cardwell
- Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN, USA
| | - Jennifer R Talackine
- Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN, USA
| | - John W Stokes
- Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN, USA
| | | | - Meredith Mentz
- Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN, USA
| | - Kaitlyn M Tracy
- Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN, USA
| | - Timothy R Harris
- Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN, USA
| | - William Tucker
- Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN, USA
| | | | - Caitlin T Demarest
- Vanderbilt University Medical Center, Department of Thoracic Surgery, Nashville, TN, USA
| | - Keith E Cook
- Carnegie Mellon University, Department of Biomedical Engineering, Pittsburgh, PA, USA
| | - David J Skoog
- Advanced Respiratory Technologies Inc, Pittsburgh, PA, USA
| | - Erika B Rosenzweig
- Columbia University Medical Center, Department of Pediatrics, New York NY, USA
| | - Matthew Bacchetta
- Vanderbilt University Medical Center, Department of Cardiac Surgery, Nashville, TN, USA; Vanderbilt University, Department of Biomedical Engineering, Nashville, TN, USA.
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Al-Adhami A, Al-Aloul M, Rushton S, Thompson RD, Carby M, Lordan J, Clark S, Spencer H, Tsui S, Parmar J. Early experience of a new national lung allocation scheme in the UK based on clinical urgency. Thorax 2023; 78:1206-1214. [PMID: 37487710 DOI: 10.1136/thorax-2022-219475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 06/21/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION A new UK Lung Allocation Scheme (UKLAS) was introduced in 2017, replacing the previous geographic allocation system. Patients are prioritised according to predefined clinical criteria into a three-tier system: the super-urgent lung allocation scheme (SULAS), the urgent lung allocation scheme (ULAS) and the non-urgent lung allocation scheme (NULAS). This study assessed the early impact of this scheme on waiting-list and post-transplant outcomes. METHODS A cohort study of adult lung transplant registrations between March 2015 and November 2016 (era-1) and between May 2017 and January 2019 (era-2). Outcomes from registration were compared between eras and stratified by urgency tier and diagnostic group. RESULTS During era-1, 461 patients were registered. In era-2, 471 patients were registered (19 (4.0%) SULAS, 82 (17.4%) ULAS and 370 (78.6%) NULAS). SULAS patients were younger (median age 35 vs 50 and 55 for urgent and non-urgent, respectively, p=0.0015) and predominantly suffered from cystic fibrosis (53%) or pulmonary fibrosis (37%). Between eras 1 and 2, the odds of transplantation within 6 months of registration were increased (OR=1.41, 95% CI 1.07 to 1.85, p=0.0142) despite only a 5% increase in transplant activity. Median time-to-transplantation during era-1 was 427 days compared with waiting times in era-2 of 8 days for SULAS, 15 days for ULAS and 585 days for NULAS patients. Waiting-list mortality (15% era-1 vs 13% era-2; p=0.5441) and post-transplant survival at 1 year (81.3% era-1 vs 83.3% era-2; p=0.6065) were similar between eras. CONCLUSION The UKLAS scheme prioritises the critically ill and improves transplantation odds. The true impact on waiting-list mortality and post-transplant survival requires further follow-up.
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Affiliation(s)
- Ahmed Al-Adhami
- Cardiothoracic Transplantation, Royal Papworth Hospital, Cambridge, UK
| | - Mohamed Al-Aloul
- Cardiothoracic Transplantation, Wythenshawe Hospital, Manchester, UK
| | - Sally Rushton
- Statistics and Clinical Studies, NHS Blood and Transplant Organ Donation and Transplantation Directorate, Bristol, UK
| | | | - Martin Carby
- Department of Cardiothoracic Transplantation, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Jordan Lordan
- Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Stephen Clark
- Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Helen Spencer
- Department of Cardiothoracic Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Steven Tsui
- Cardiothoracic Transplantation, Royal Papworth Hospital, Cambridge, UK
| | - Jasvir Parmar
- Cardiothoracic Transplantation, Royal Papworth Hospital, Cambridge, UK
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van Zijl NLF, Janson JT, Sussman M, Geldenhuys A. Extracorporeal membrane oxygenation in South Africa: Experience from a single centre in the private sector. Afr J Thorac Crit Care Med 2023; 29:e211. [PMID: 38239776 PMCID: PMC10795019 DOI: 10.7196/ajtccm.2023.v29i4.211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/10/2023] [Indexed: 01/22/2024] Open
Abstract
Background Extracorporeal membrane oxygenation (ECMO) is an advanced, resource-intensive technology used in a limited capacity in South Africa (SA). Minimal data on the use of ECMO in SA are available. Objectives To describe the indications, early outcome and comorbidities of patients placed on ECMO in the highest-volume ECMO centre in SA. Methods We performed a single-centre retrospective review of all adult patients supported with any form of ECMO from August 2016 to December 2018. Operative and clinical records were reviewed. The primary objective of this study was to review the outcome of patients placed on ECMO in the form of survival to hospital discharge. The secondary objectives were to identify population-specific comorbidities and indications for ECMO that could be associated with non-survival and to compare outcome with known risk scores in the form of the Respiratory ECMO Survival Prediction (RESP) and Survival After Venoarterial ECMO (SAVE) scores. Results One hundred and seven patients were identified. The primary indication for ECMO was respiratory support in 78 patients and cardiac support in 29 patients. Forty-seven patients were discharged from hospital, with a 44.0% overall survival rate. Gender (p=0.039), age (p=0.019) and hypertension (p=0.022) were associated with death in univariate logistic regression analysis. However, after adjusting for potential confounding in multivariate logistic regression analysis, the association was no longer significant. In the all respiratory support group, patients in risk class IV had better than predicted survival according to the RESP score, while risk classes I, II and III had worse than predicted survival. In the circulatory support group, all risk classes had worse than predicted survival according to the SAVE score. Conclusion We report ECMO outcomes in SA for the first time. We identified very high mortality rates for patients transferred on ECMO from other facilities and for patients converted from venovenous ECMO to venoarterial ECMO. Although our outcomes were comparable in some of the risk classes, further external validation of the SAVE and RESP scores will be needed to compare our outcomes with these scores. Study synopsis What the study adds. We report on extracorporeal membrane oxygenation (ECMO) outcomes in South Africa for the first time. We identified a high mortality rate in patients transferred on ECMO from other facilities, and in patients converted from venovenous ECMO to venoarterial ECMO.Implications of the findings. Transferred patients had a high mortality rate. The reason for this should be further investigated and may highlight the need for possible protocols to assist with appropriate timing of patient transfers and possible earlier intervention or transfer.
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Affiliation(s)
- N L F van Zijl
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J T Janson
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Sussman
- Netcare Milpark Hospital, Johannesburg, South Africa
| | - A Geldenhuys
- Netcare Milpark Hospital, Johannesburg, South Africa
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Faccioli E, Lorenzoni G, Schneiter D, Dell’Amore A, Hillinger S, Schiavon M, Caviezel C, Gregori D, Rea F, Opitz I, Inci I. Validated Prognostic Scores to Predict Outcomes in ECLS-Bridged Patients to Lung Transplantation. Transpl Int 2023; 36:11609. [PMID: 37965627 PMCID: PMC10642624 DOI: 10.3389/ti.2023.11609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023]
Abstract
Selection of patients who may benefit from extracorporeal life support (ECLS) as a bridge to lung transplant (LTx) is crucial. The aim was to assess if validated prognostic scores could help in selecting patients who may benefit from ECLS-bridging predicting their outcomes. Clinical data of patients successfully ECLS-bridged to LTx from 2009 to 2021 were collected from two European centers. For each patient, we calculated Sequential Organ Failure Assessment (SOFA), Simplified Acute Physiology Score III (SAPS III), Acute Physiology and Chronic Health Evaluation II (APACHE II), before placing ECLS support, and then correlated with outcome. Median values of SOFA, SAPS III, and APACHE II were 5 (IQR 3-9), 57 (IQR 47.5-65), and 21 (IQR 15-26). In-hospital, 30 and 90 days mortality were 21%, 14%, and 22%. SOFA, SAPS III, and APACHE II were analyzed as predictors of in-hospital, 30 and 90 days mortality (SOFA C-Index: 0.67, 0.78, 0.72; SAPS III C-index: 0.48, 0.45, 0.51; APACHE II C-Index: 0.49, 0.45, 0.52). For SOFA, the score with the best performance, a value ≥9 was identified to be the optimal cut-off for the prediction of the outcomes of interest. SOFA may be considered an adequate predictor in these patients, helping clinical decision-making. More specific and simplified scores for this population are necessary.
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Affiliation(s)
- Eleonora Faccioli
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padua, Padua, Italy
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic Vascular Sciences and Public Health University of Padua, Padua, Italy
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Andrea Dell’Amore
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padua, Padua, Italy
| | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padua, Padua, Italy
| | - Claudio Caviezel
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic Vascular Sciences and Public Health University of Padua, Padua, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padua, Padua, Italy
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
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10
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Hoetzenecker K, Schwarz S, Keshavjee S, Cypel M. Lung transplantation for acute respiratory distress syndrome. J Thorac Cardiovasc Surg 2023; 165:1596-1601. [PMID: 35379475 DOI: 10.1016/j.jtcvs.2022.02.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/19/2022] [Accepted: 02/10/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Schwarz
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Shaf Keshavjee
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marcelo Cypel
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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11
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Natalini JG, Clausen ES. Critical Care Management of the Lung Transplant Recipient. Clin Chest Med 2023; 44:105-119. [PMID: 36774158 DOI: 10.1016/j.ccm.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Lung transplantation is often the only treatment option for patients with severe irreversible lung disease. Improvements in donor and recipient selection, organ allocation, surgical techniques, and immunosuppression have all contributed to better survival outcomes after lung transplantation. Nonetheless, lung transplant recipients still experience frequent complications, often necessitating treatment in an intensive care setting. In addition, the use of extracorporeal life support as a means of bridging critically ill patients to lung transplantation has become more widespread. This review focuses on the critical care aspects of lung transplantation, both before and after surgery.
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Affiliation(s)
- Jake G Natalini
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University Grossman School of Medicine, 530 First Avenue, HCC 4A, New York, NY 10016, USA.
| | - Emily S Clausen
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce Street, 9036 Gates Building, Philadelphia, PA 19104, USA
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12
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Ndubisi N, van Berkel V. Veno-venous extracorporeal membrane oxygenation for the treatment of respiratory compromise. Indian J Thorac Cardiovasc Surg 2023; 39:1-7. [PMID: 36778720 PMCID: PMC9905006 DOI: 10.1007/s12055-022-01467-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 02/11/2023] Open
Abstract
Extracorporeal membrane oxygenation for the purpose of intervening upon profound cardiovascular or pulmonary compromise has proven to be a worthy intervention. Technological advancements have allowed this mode of therapy to become more effective and widespread. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a commonly used strategy to help manage patients with pulmonary dysfunction refractory to traditional management methods. This review intends to focus upon common indications and the clinical considerations for the institution of VV-ECMO as well as some of its known complications.
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Affiliation(s)
- Nnaemeka Ndubisi
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, 201 Abraham Flexnor Way, Suite 1200, Louisville, KY 40202 USA
| | - Victor van Berkel
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, 201 Abraham Flexnor Way, Suite 1200, Louisville, KY 40202 USA
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13
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Improved Outcomes for Infants and Young Children Undergoing Lung Transplantation at Three Years of Age and Younger. Ann Am Thorac Soc 2023; 20:254-261. [PMID: 36260085 DOI: 10.1513/annalsats.202202-093oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Rationale: Since its inception, older children and adolescents have predominated in pediatric lung transplantation. Most pediatric lung transplant programs around the world have transplanted few infants and young children. Early mortality after lung transplantation and inadequate donor organs have been perceived as limitations for success in lung transplantation at this age. Objectives: Our aim was to describe our experience in a large pediatric lung transplant program with respect to lung transplantation in infants and young children, focusing on diagnosis, waitlist, and mortality. Methods: We performed a retrospective review of infants and young children under 3 years of age at the time of transplant in our program from 2002 through 2020. Results: The patient cohort represented a severely morbid recipient group, with the majority hospitalized in the intensive care unit on mechanical ventilation just before transplantation. There was a marked heterogeneity of diagnoses distinct from diagnoses in an older cohort. Waitlist time was shorter than in older age cohorts. There was a decrease in early mortality, lower incidence of allograft rejection, and satisfactory long-term survival in this age group compared with the older cohort and published experience. Severe viral infection was an important cause of early mortality after transplant. Nonetheless, survival is comparable to older patients, with better enduring survival in those who survive the early transplant period in more recent years. Conclusions: Carefully selected infants and young children with end-stage lung and pulmonary vascular disease are appropriate candidates for lung transplantation and are likely underserved by current clinical practice.
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14
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Orozco-Hernandez E, DeLay TK, Gongora E, Bellot C, Rusanov V, Wille K, Tallaj J, Pamboukian S, Kaleekal T, Mcelwee S, Hoopes C. State of the art - Extracorporeal membrane oxygenation as a bridge to thoracic transplantation. Clin Transplant 2023; 37:e14875. [PMID: 36465026 DOI: 10.1111/ctr.14875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/11/2022] [Accepted: 11/28/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) has revolutionized the treatment of refractory cardiac and respiratory failure, and its use continues to increase, particularly in adults. However, ECMO-related morbidity and mortality remain high. MAIN TEXT In this review, we investigate and expand upon the current state of the art in thoracic transplant and extracorporeal life support (ELS). In particular, we examine recent increase in incidence of heart transplant in patients supported by ECMO; the potential changes in patient care and selection for transplant in the years prior to updated United Network for Organ Sharing (UNOS) organ allocation guidelines versus those in the years following, particularly where these guidelines pertain to ECMO; and the newly revived practice of heart-lung block transplants (HLT) and the prevalence and utility of ECMO support in patients listed for HLT. CONCLUSIONS Our findings highlight encouraging outcomes in patients bridged to transplant with ECMO, considerable changes in treatment surrounding the updated UNOS guidelines, and complex, diverse outcomes among different centers in their care for increasingly ill patients listed for thoracic transplant.
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Affiliation(s)
- Erik Orozco-Hernandez
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Thomas Kurt DeLay
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Enrique Gongora
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Chris Bellot
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Victoria Rusanov
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Keith Wille
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jose Tallaj
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Salpy Pamboukian
- Division of Cardiology, University of Washington, Birmingham, Alabama, USA
| | - Thomas Kaleekal
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sam Mcelwee
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charles Hoopes
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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15
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Wieruszewski PM, Ortoleva JP, Cormican DS, Seelhammer TG. Extracorporeal Membrane Oxygenation in Acute Respiratory Failure. Pulm Ther 2023; 9:109-126. [PMID: 36670314 PMCID: PMC9859746 DOI: 10.1007/s41030-023-00214-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
Venovenous (VV) extracorporeal membrane oxygenation (ECMO) is a form of mechanical life support that provides full respiratory bypass in patients with severe respiratory failure as a bridge to recovery or lung transplantation. The use of ECMO for respiratory failure and capable centers offering ECMO has expanded over the years, increasing its availability. As VV-ECMO provides an artificial mechanism for oxygenation and decarboxylation of native blood, it allows for an environment in which safer mechanical ventilatory care may be provided, allowing for treatment and resolution of underlying respiratory pathologies. Landmark clinical trials have provided a framework for better understanding patient selection criteria, resource utilization, and outcomes associated with ECMO when applied in settings of refractory respiratory failure. Maintaining close vigilance and management of complications during ECMO as well as identifying strategies post-ECMO (e.g., recovery, transplantation, etc.), are critical to successful ECMO support. In this review, we examine considerations for candidate selection for VV-ECMO, review the evidence of utilizing VV-ECMO in respiratory failure, and provide practical considerations for managing respiratory ECMO patients, including complication identification and management, as well as assessing for the ability to separate from ECMO support and the procedures for decannulation.
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Affiliation(s)
- Patrick M. Wieruszewski
- Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA ,Department of Pharmacy, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Jamel P. Ortoleva
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA USA
| | - Daniel S. Cormican
- Division of Cardiothoracic Anesthesiology, Allegheny General Hospital, Pittsburg, PA USA
| | - Troy G. Seelhammer
- Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
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16
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Alamri AK, Shelburne NJ, Mayeux JD, Brittain E. Pulmonary Hypertension Association's 2022 International Conference Scientific Sessions Overview. Pulm Circ 2023; 13:e12182. [PMID: 36644322 PMCID: PMC9832865 DOI: 10.1002/pul2.12182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
The considerable progress made in recent years in the diagnosis, risk stratification, and treatment of pulmonary hypertension was highlighted during the most recent edition of the Pulmonary Hypertension Association Scientific Sessions, which was held in Atlanta, Georgia from June 9 to 11, 2022, with the theme: Vision for the PHuture: The Evolving Science and Management of PH. Content presented over the 3-day conference focused on scientific and management updates since the last sessions were held in 2018 and included didactic talks, debates, and roundtable discussions across a broad spectrum of topics related to pulmonary hypertension. This article aims to summarize the key messages from each of the session talks.
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Affiliation(s)
- Ayedh K. Alamri
- Department of MedicineUniversity of UtahSalt Lake CityUtahUSA,Department of Medicine, College of MedicineNorthern Border UniversityArarSaudi Arabia
| | - Nicholas J. Shelburne
- Division of Allergy, Pulmonary, and Critical Care MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jennalyn D. Mayeux
- Department of Medicine, Division of Pulmonary and Critical Care MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - Evan Brittain
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
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17
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Hartwig M, van Berkel V, Bharat A, Cypel M, Date H, Erasmus M, Hoetzenecker K, Klepetko W, Kon Z, Kukreja J, Machuca T, McCurry K, Mercier O, Opitz I, Puri V, Van Raemdonck D. The American Association for Thoracic Surgery (AATS) 2022 Expert Consensus Document: The use of mechanical circulatory support in lung transplantation. J Thorac Cardiovasc Surg 2023; 165:301-326. [PMID: 36517135 DOI: 10.1016/j.jtcvs.2022.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/26/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The use of mechanical circulatory support (MCS) in lung transplantation has been steadily increasing over the prior decade, with evolving strategies for incorporating support in the preoperative, intraoperative, and postoperative settings. There is significant practice variability in the use of these techniques, however, and relatively limited data to help establish institutional protocols. The objective of the AATS Clinical Practice Standards Committee (CPSC) expert panel was to review the existing literature and establish recommendations about the use of MCS before, during, and after lung transplantation. METHODS The AATS CPSC assembled an expert panel of 16 lung transplantation physicians who developed a consensus document of recommendations. The panel was broken into subgroups focused on preoperative, intraoperative, and postoperative support, and each subgroup performed a focused literature review. These subgroups formulated recommendation statements for each subtopic, which were evaluated by the entire group. The statements were then developed via discussion among the panel and refined until consensus was achieved on each statement. RESULTS The expert panel achieved consensus on 36 recommendations for how and when to use MCS in lung transplantation. These recommendations included the use of veno-venous extracorporeal membrane oxygenation (ECMO) as a bridging strategy in the preoperative setting, a preference for central veno-arterial ECMO over traditional cardiopulmonary bypass during the transplantation procedure, and the benefit of supporting selected patients with MCS postoperatively. CONCLUSIONS Achieving optimal results in lung transplantation requires the use of a wide range of strategies. MCS provides an important mechanism for helping these critically ill patients through the peritransplantation period. Despite the complex nature of the decision making process in the treatment of these patients, the expert panel was able to achieve consensus on 36 recommendations. These recommendations should provide guidance for professionals involved in the care of end-stage lung disease patients considered for transplantation.
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Affiliation(s)
- Matthew Hartwig
- Division of Thoracic Surgery, Duke University Medical Center, Durham, NC.
| | | | | | | | - Hiroshi Date
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Michiel Erasmus
- University Academic Center Groningen, Groningen, The Netherlands
| | | | | | | | - Jasleen Kukreja
- University of California San Francisco, San Francisco, Calif
| | - Tiago Machuca
- University of Florida College of Medicine, Gainesville, Fla
| | | | - Olaf Mercier
- Université Paris-Saclay and Marie Lannelongue Hospital, Le Plessis-Robinson, France
| | | | - Varun Puri
- Washington University School of Medicine, St Louis, Mo
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18
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Abstract
BACKGROUND Donor-specific antibodies (DSAs) have been associated with antibody-mediated rejection, chronic lung allograft dysfunction (CLAD), and increased mortality in lung transplant recipients. Our center performs transplants in the presence of DSA, and we sought to evaluate the safety of this practice with respect to graft loss, CLAD onset, and primary graft dysfunction (PGD). METHODS We reviewed recipients transplanted from 2010 to 2017, classifying them as DSA positive (DSA+) or negative. We used Kaplan-Meier estimation to test the association between DSA status and time to death or retransplant and time to CLAD onset. We further tested associations with severe PGD and rejection in the first year using logistic regression and Fisher exact testing. RESULTS Three hundred thirteen patients met inclusion criteria, 30 (10%) of whom were DSA+. DSA+ patients were more likely to be female, bridged to transplant, and receive induction therapy. There was no association between DSA status and time to death or retransplant (log rank P = 0.581) nor death-censored time to CLAD onset (log rank P = 0.278), but DSA+ patients were at increased risk of severe PGD (odds ratio 2.88; 95% confidence interval, 1.10-7.29; P = 0.031) and more frequent antibody-mediated rejection in the first posttransplant year. CONCLUSIONS Crossing DSA at time of lung transplant was not associated with an increased risk of death or CLAD in our cohort, but patients developed severe PGD and antibody-mediated rejection more frequently. However, these risks are likely manageable when balanced against the benefits of expanded access for sensitized candidates.
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19
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Perez AA, Shah RJ. Critical Care of the Lung Transplant Patient. Clin Chest Med 2022; 43:457-470. [PMID: 36116814 DOI: 10.1016/j.ccm.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Lung transplantation is a therapeutic option for end-stage lung disease that improves survival and quality of life. Prelung transplant admission to the intensive care unit (ICU) for bridge to transplant with mechanical ventilation and extracorporeal membrane oxygenation (ECMO) is common. Primary graft dysfunction is an important immediate complication of lung transplantation with short- and long-term morbidity and mortality. Later transplant-related causes of respiratory failure necessitating ICU admission include acute cellular rejection, atypical infections, and chronic lung allograft dysfunction. Lung transplantation for COVID-19-related ARDS is increasingly common..
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Affiliation(s)
- Alyssa A Perez
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, 400 Parnassus Street, 5th Floor, San Francisco, CA 94143, USA.
| | - Rupal J Shah
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, 400 Parnassus Street, 5th Floor, San Francisco, CA 94143, USA
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20
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Chiel LE, Winthrop ZA, Fynn-Thompson F, Midyat L. Extracorporeal membrane oxygenation and paracorporeal lung assist devices as a bridge to pediatric lung transplantation. Pediatr Transplant 2022; 26:e14289. [PMID: 35416395 DOI: 10.1111/petr.14289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND "Bridging" is a term used to describe the implementation of various treatment modalities to improve waitlist survival while a patient awaits lung transplantation. ECMO and PLAD are technologies used to bridge patients to lung transplantation. ECMO and PLAD are cardiopulmonary support systems that help move blood forward while using an artificial membrane to remove CO2 from and add O2 to the blood. Recent studies showed that these technologies are increasingly effective in bridging patients to lung transplantation, especially with optimizing patient selection, implementing physical rehabilitation and ambulation goals, standardization of management decisions, and increasing staff experience, among other considerations. We review these technologies, their roles as bridges to pediatric lung transplantation, as well as indications, contraindications, complications, and mortality rates. CONCLUSION Finally, we discuss the existing knowledge gaps and areas for future research to improve patient outcomes and understanding of lung assist devices.
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Affiliation(s)
- Laura E Chiel
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zachary A Winthrop
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Francis Fynn-Thompson
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Levent Midyat
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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21
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Cucchi M, Mariani S, De Piero ME, Ravaux JM, Kawczynski MJ, Di Mauro M, Shkurka E, Hoskote A, Lorusso R. Awake extracorporeal life support and physiotherapy in adult patients: A systematic review of the literature. Perfusion 2022:2676591221096078. [PMID: 35760523 DOI: 10.1177/02676591221096078] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The Awake Extracorporeal Life Support (ECLS) practice combined with physiotherapy is increasing. However, available evidence for this approach is limited, with unclear indications on timing, management, and protocols. This review summarizes available literature regarding Awake ECLS and physiotherapy application rates, practices, and outcomes in adults, providing indications for future investigations. METHODS Four databases were screened from inception to February 2021, for studies reporting adult Awake ECLS with/without physiotherapy. Primary outcome was hospital discharge survival, followed by Extracorporeal Membrane Oxygenation (ECMO) duration, extubation, Intensive Care Unit stay. RESULTS Twenty-nine observational studies and one randomized study were selected, including 1,157 patients (males n = 611/691, 88.4%) undergoing Awake ECLS. Support type was reported in 1,089 patients: Veno-Arterial ECMO (V-A = 39.6%), Veno-Venous ECMO (V-V = 56.8%), other ECLS (3.6%). Exclusive upper body cannulation and femoral cannulation were applied in 31% versus 69% reported cases (n = 931). Extubation was successful in 63.5% (n = 522/822) patients during ECLS. Physiotherapy details were given for 676 patients: exercises confined in bed for 47.9% (n = 324) patients, mobilization until standing in 9.3% (n = 63) cases, ambulation performed in 42.7% (n = 289) patients. Femoral cannulation, extubation and V-A ECMO were mostly correlated to complications. Hospital discharge survival observed in 70.8% (n = 789/1114). CONCLUSION Awake ECLS strategy associated with physiotherapy is performed regardless of cannulation approach. Ambulation, as main objective, is achieved in almost half the population examined. Prospective studies are needed to evaluate safety and efficacy of physiotherapy during Awake ECLS, and suitable patient selection. Guidelines are required to identify appropriate assessment/evaluation tools for Awake ECLS patients monitoring.
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Affiliation(s)
- Marta Cucchi
- Cardio-Thoracic Surgery Department, and Cardiology Department, Heart and Vascular Center, 199236Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Silvia Mariani
- Cardio-Thoracic Surgery Department, and Cardiology Department, Heart and Vascular Center, 199236Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Maria E De Piero
- Cardio-Thoracic Surgery Department, and Cardiology Department, Heart and Vascular Center, 199236Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Justine M Ravaux
- Cardio-Thoracic Surgery Department, and Cardiology Department, Heart and Vascular Center, 199236Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Michal J Kawczynski
- Cardio-Thoracic Surgery Department, and Cardiology Department, Heart and Vascular Center, 199236Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Department, and Cardiology Department, Heart and Vascular Center, 199236Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Emma Shkurka
- Cardiac Intensive Care Unit, 4956Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Aparna Hoskote
- Cardiac Intensive Care Unit, 4956Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, and Cardiology Department, Heart and Vascular Center, 199236Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
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22
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Managing pulmonary arterial hypertension: how to select and facilitate successful transplantation. Curr Opin Organ Transplant 2022; 27:169-176. [PMID: 35649107 DOI: 10.1097/mot.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Despite improvements in available medical therapies, pulmonary arterial hypertension (PAH) remains a progressive, ultimately fatal disorder. Lung transplantation is a viable treatment option for PAH patients with advanced disease. RECENT FINDINGS Recent guidelines from the International Society of Heart and Lung Transplantation (ISHLT) have updated recommendations regarding time of referral and listing for lung transplantation in PAH. The new guidelines emphasize earlier referral for transplant evaluation to ensure adequate time for proper evaluation and listing. They also incorporate objective risk stratification criteria to assist in decision-making regarding timing of referral and listing. With regards to the transplant procedure, bilateral lung transplantation has largely supplanted heart-lung transplantation as the procedure of choice for transplantation for advanced PAH. Exceptions to this include patients with PAH because of congenital heart disease and those with concurrent LV dysfunction. Use of mechanical support via venoarterial ECMO initiated before transplantation and continued into the early postoperative period is emerging as a standard of care and may help to reduce early posttransplant mortality in this population. There has been increased recognition of the importance of WHO Group 3 pulmonary hypertension. Many of the lessons learned from PAH may be applied when transplanting patients with severe WHO Group 3 pulmonary hypertension. SUMMARY Patients with PAH present unique challenges with regards to transplantation that require a therapeutic approach distinct from other lung disorders. Lung transplantations for PAH are high-risk endeavors best performed at centers with expertise in management of both PAH and extracorporeal support.
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23
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Patterson CM, Shah A, Rabin J, DiChiacchio L, Cypel M, Hoetzenecker K, Catarino P, Lau CL. EXTRACORPOREAL LIFE SUPPORT AS A BRIDGE TO LUNG TRANSPLANTATION: WHERE ARE WE NOW? J Heart Lung Transplant 2022; 41:1547-1555. [DOI: 10.1016/j.healun.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/21/2022] [Accepted: 06/05/2022] [Indexed: 11/16/2022] Open
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A Dual-lumen Extracorporal Membrane Oxygenation Cannulation Technique Using a Mobile X-ray Device. Ann Thorac Surg 2022; 114:1050-1054. [PMID: 35504359 DOI: 10.1016/j.athoracsur.2022.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/25/2022] [Accepted: 04/10/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Dual-lumen extracorporal membrane oxygenation (ECMO) cannulation is considered technically challenging and harbors the risk for potential life-threatening complications during cannulation. Dual-lumen cannula insertion is either performed under ultrasound or fluoroscopy guidance. Both techniques have significant disadvantages, such as examiner-dependence or the necessity for transportation of the patient from the intensive care unit (ICU) to the operating room. DESCRIPTION Digital, mobile X-ray devices provide a novel, examiner-independent imaging modality for bedside dual-lumen ECMO cannulation. EVALUATION From 11/2019 to 11/2021, 23 dual-lumen cannulations were performed in 20 patients at the Department of Thoracic Surgery, Medical University of Vienna. 12/23 (52.2%) were inserted in the ICU using a mobile X-ray device. The remaining patients (47.8%) were cannulated in the operating room with conventional fluoroscopy guidance. In none of the procedures cardiovascular injuries occurred. Insertion site bleeding was the most common ECMO-related complication (n=2). CONCLUSIONS Dual-lumen cannulation using sequential X-rays can be performed safely. Especially in infectious patients or patients who require an awake ECMO, this technique overcomes disadvantages of established imaging modalities.
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25
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Murray AW, Boisen ML, Fritz A, Renew JR, Martin AK. Anesthetic considerations in lung transplantation: past, present and future. J Thorac Dis 2022; 13:6550-6563. [PMID: 34992834 PMCID: PMC8662503 DOI: 10.21037/jtd-2021-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/10/2021] [Indexed: 01/01/2023]
Abstract
Lung transplantation is a very complex surgical procedure with many implications for the anesthetic care of these patients. Comprehensive preoperative evaluation is an important component of the transplant evaluation as it informs many of the decisions made perioperatively to manage these complex patients effectively and appropriately. These decisions may involve pre-emptive actions like pre-habilitation and nutrition optimization of these patients before they arrive for their transplant procedure. Appropriate airway and ventilation management of these patients needs to be performed in a manner that provides an optimal operating conditions and protection from ventilatory injury of these fragile post-transplant lungs. Pain management can be challenging and should be managed in a multi-modal fashion with or without the use of an epidural catheter while recognizing the risk of neuraxial technique in patients who will possibly be systemically anticoagulated. Complex monitoring is required for these patients involving both invasive and non-invasive including the use of transesophageal echocardiography (TEE) and continuous cardiac output monitoring. Management of the patient's hemodynamics can be challenging and involves managing the systemic and pulmonary vascular systems. Some patients may require extra-corporeal lung support as a planned part of the procedure or as a rescue technique and centers need to be proficient in instituting and managing this sophisticated method of hemodynamic support.
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Affiliation(s)
- Andrew W Murray
- Department of Anesthesiology, Mayo Clinic Graduate School of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ashley Fritz
- Division of Cardiothoracic and Thoracic Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
| | - J Ross Renew
- Department of Anesthesiology, Mayo Clinic Graduate School of Medicine, Mayo Clinic, Jacksonville, FL, USA
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Abstract
Acute exacerbation is a major cause of morbidity and mortality in patients with idiopathic pulmonary fibrosis. Although the real nature of it is still not clear and there is no proven effective therapy, progress has been made since the consensus definition and diagnostic criteria were proposed. The trial results of several new innovative therapies in idiopathic pulmonary fibrosis have suggested a potential for benefit in acute exacerbation of idiopathic pulmonary fibrosis, leading to double blind randomized clinical trials in this area. This article reviews the present knowledge on acute exacerbation of idiopathic pulmonary fibrosis, focusing on the triggering factors and treatment.
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Xia Y, Ragalie W, Yang E, Lluri G, Biniwale R, Benharash P, Gudzenko V, Saggar R, Sayah D, Ardehali A. Venoarterial Versus Venovenous Extracorporeal Membrane Oxygenation as Bridge to Lung Transplantation. Ann Thorac Surg 2021; 114:2080-2086. [PMID: 34906571 DOI: 10.1016/j.athoracsur.2021.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/01/2021] [Accepted: 11/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) has been used as a bridge to lung transplantation with acceptable outcomes. We hypothesized that VA ECMO, as part of a multidisciplinary ECMO program, yields similar outcomes as VV ECMO as a bridge in lung transplantation. METHODS Records of all patients who had undergone ECMO with the intention to bridge to lung transplantation at University of California Los Angeles from January 1, 2012 to March 31, 2020 were reviewed. Baseline characteristics, in-hospital outcomes, long-term survival, and freedom from bronchiolitis obliterans syndrome (BOS) were assessed. RESULTS During this interval, 58 patients were placed on ECMO with the intention to bridge to lung transplantation: 27 on VV ECMO, and 31 on VA ECMO with a median duration of 7 and 17 days of support, respectively(p=0.01). Successful bridge to lung transplantation occurred in 21(78%) VV and 26(84%) VA patients. Incidence of primary graft dysfunction III(PGD III) at 72 hours in the VV and the VA cohorts were 0% and 4%, respectively(p=0.99). In-hospital and 90-day survival of the VV and VA groups were 100% and 96%, respectively(p=0.99). Three-year survival of the two groups were not significantly different from a contemporary cohort of lung transplant recipients not bridged with ECMO. CONCLUSIONS VA and VV ECMO can both be used as a bridge to lung transplantation with high success, with short and medium-term survival similar to non-bridged lung transplant recipients. Both modes should be considered effective at bridging select candidates to lung transplantation.
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Affiliation(s)
- Yu Xia
- University of California Los Angeles, Department of Surgery, Division of Cardiac Surgery.
| | - William Ragalie
- University of California Los Angeles, Department of Surgery, Division of Cardiac Surgery
| | - Eric Yang
- University of California Los Angeles, Department of Medicine, Division of Cardiology
| | - Gentian Lluri
- University of California Los Angeles, Department of Medicine, Division of Cardiology
| | - Reshma Biniwale
- University of California Los Angeles, Department of Surgery, Division of Cardiac Surgery
| | - Peyman Benharash
- University of California Los Angeles, Department of Surgery, Division of Cardiac Surgery
| | - Vadim Gudzenko
- University of California Los Angeles, Department of Anesthesiology
| | - Rajan Saggar
- University of California Los Angeles, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine
| | - David Sayah
- University of California Los Angeles, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine
| | - Abbas Ardehali
- University of California Los Angeles, Department of Surgery, Division of Cardiac Surgery
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Kim NE, Woo A, Kim SY, Leem AY, Park Y, Kwak SH, Yong SH, Chung K, Park MS, Kim YS, Kim HE, Lee JG, Paik HC, Lee SH. Long- and short-term clinical impact of awake extracorporeal membrane oxygenation as bridging therapy for lung transplantation. Respir Res 2021; 22:306. [PMID: 34839821 PMCID: PMC8627606 DOI: 10.1186/s12931-021-01905-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background As lung transplantation (LTx) is becoming a standard treatment for end-stage lung disease, the use of bridging with extracorporeal membrane oxygenation (ECMO) is increasing. We examined the clinical impact of being awake during ECMO as bridging therapy in patients awaiting LTx.
Methods In this single-center study, we retrospectively reviewed 241 consecutive LTx patients between October 2012 and March 2019; 64 patients received ECMO support while awaiting LTx. We divided into awake and non-awake groups and compared. Results Twenty-five patients (39.1%) were awake, and 39 (61.0%) were non-awake. The median age of awake patients was 59.0 (interquartile range, 52.5–63.0) years, and 80% of the group was men. The awake group had better post-operative outcomes than the non-awake group: statistically shorter post-operative intensive care unit length of stay [awake vs. non-awake, 6 (4–8.5) vs. 18 (11–36), p < 0.001], longer ventilator free days [awake vs. non-awake, 24 (17–26) vs. 0 (0–15), p < 0.001], and higher gait ability after LTx (awake vs. non-awake, 92% vs. 59%, p = 0.004), leading to higher 6-month and 1-year lung function (forced expiratory volume in 1 s: awake vs. non-awake, 6-month, 77.5% vs. 61%, p = 0.004, 1-year, 75% vs. 57%, p = 0.013). Furthermore, the awake group had significantly lower 6-month and 1-year mortality rates than the non-awake group (6-month 12% vs. 38.5%, p = 0.022, 1-year 24% vs. 53.8%, p = 0.018). Conclusions In patients with end-stage lung disease, considering the long-term and short-term impacts, the awake ECMO strategy could be useful compared with the non-awake ECMO strategy. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01905-7.
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Affiliation(s)
- Nam Eun Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University College of Medicine, Ewha Womans Seoul Hospital, Seoul, South Korea
| | - Ala Woo
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Song Yee Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Ah Young Leem
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Youngmok Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Se Hyun Kwak
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Seung Hyun Yong
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Kyungsoo Chung
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Moo Suk Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Young Sam Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Ha Eun Kim
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Su Hwan Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Rehabilitation of adult patients on extracorporeal membrane oxygenation: A scoping review. Aust Crit Care 2021; 35:575-582. [PMID: 34711492 DOI: 10.1016/j.aucc.2021.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The objective of this study was to conduct a scoping review to comprehensively map the breadth of literature related to the rehabilitation of adult patients whilst on extracorporeal membrane oxygenation (ECMO) and identify gaps and areas for future research. REVIEW METHOD USED This review was conducted using recommended frameworks for methods and reporting including the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. DATE SOURCES We searched seven databases from inception to June 2021 and included all study designs and grey literature. REVIEW METHODS Eligibility screening was completed by two independent reviewers according to inclusion and exclusion criteria, with any disagreement resolved by consensus or with consultation with a third reviewer. Two independent reviewers extracted data related to intervention characteristics, patient outcomes, feasibility, safety, hospital outcomes, and mortality using a custom-designed piloted form. RESULTS Of 8507 records, 185 original studies met inclusion criteria, with the majority being small retrospective studies. Rehabilitation was more commonly reported in patients on veno-venous rather than veno-arterial ECMO. Ambulation was the most commonly reported intervention (51% of studies). Critical gaps were identified including incomplete reporting of the intervention along with heterogeneity in the type and timing of outcome measures. Less than 50% of patients met eligibility criteria to participate, but screening for eligibility was infrequently reported (9% of studies). Delivery of rehabilitation during ECMO may be facilitated by an expert multidisciplinary team, along with a strategy that targets low sedation levels and an upper body cannulation approach. CONCLUSIONS Rehabilitation during ECMO is an emerging area of research and mostly consisted of small retrospective single-centre studies. Future research requires more robust methodological designs that include comprehensive screening of potential candidates with reporting of eligibility, more detailed descriptions of the rehabilitation interventions, inclusion of a core outcome set with defined measurement instruments, and consistent timing of outcome measurement.
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Copeland H, Levine D, Morton J, Hayanga JA. Acute respiratory distress syndrome in the cardiothoracic patient: State of the art and use of veno-venous extracorporeal membrane oxygenation. ACTA ACUST UNITED AC 2021; 8:97-103. [PMID: 34723221 PMCID: PMC8541831 DOI: 10.1016/j.xjon.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 10/12/2021] [Indexed: 01/02/2023]
Affiliation(s)
- Hannah Copeland
- Division of Cardiovascular Surgery, Division of Heart Transplantation, Mechanical Circulatory Support and ECMO, Lutheran Hospital, Fort Wayne, Ind
- Indiana University School of Medicine Fort Wayne, Fort Wayne, Ind
- Address for reprints: Hannah Copeland, MD, Indiana University–Fort Wayne School of Medicine, 7910 W Jefferson Blvd, Suite 102, Fort Wayne, IN 46804.
| | - Deborah Levine
- Division of Pulmonary Critical Care and Lung Transplantation, Department of Medicine, University of Texas San Antonio, San Antonio, Tex
| | - John Morton
- Division of Cardiovascular Surgery, Division of Heart Transplantation, Mechanical Circulatory Support and ECMO, Lutheran Hospital, Fort Wayne, Ind
| | - J.W. Awori Hayanga
- Department of Thoracic and Cardiovascular Surgery, West Virginia University, Morgantown, WVa
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Keshavamurthy S, Bazan V, Tribble TA, Baz MA, Zwischenberger JB. Ambulatory extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation. Indian J Thorac Cardiovasc Surg 2021; 37:366-379. [PMID: 34483506 PMCID: PMC8408364 DOI: 10.1007/s12055-021-01210-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/29/2021] [Accepted: 05/02/2021] [Indexed: 11/25/2022] Open
Abstract
Ambulatory extracorporeal membrane oxygenation (ECMO) has shown promise as a bridge to lung transplantation. The primary goal of ambulatory ECMO is to provide enough gas exchange to allow patients to participate in preoperative physical therapy. Various strategies of ambulatory ECMO are utilized depending upon patients’ need. A wide spectrum of ECMO configurations is available to tackle this situation. We discuss those configurations in this article.
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Affiliation(s)
- Suresh Keshavamurthy
- Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky College of Medicine, 740 S. Limestone, A-301, Lexington, KY 40536 USA
| | - Vanessa Bazan
- University of Kentucky College of Medicine, William R. Willard Medical Education Building, MN 150, Lexington, KY 40536 USA
| | - Thomas Andrew Tribble
- Mechanical Circulatory Support Coordinator, MCS Department, Gill Heart & Vascular Institute, 1000 S. Limestone Pav A.08.273, Lexington, KY 40536 USA
| | - Maher Afif Baz
- Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky College of Medicine, 740 S. Limestone, A-301, Lexington, KY 40536 USA
| | - Joseph Bertram Zwischenberger
- Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky College of Medicine, 740 S. Limestone, A-301, Lexington, KY 40536 USA
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Faccioli E, Terzi S, Pangoni A, Lomangino I, Rossi S, Lloret A, Cannone G, Marino C, Catelli C, Dell'Amore A. Extracorporeal membrane oxygenation in lung transplantation: Indications, techniques and results. World J Transplant 2021; 11:290-302. [PMID: 34316453 PMCID: PMC8290996 DOI: 10.5500/wjt.v11.i7.290] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/13/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
The use of extracorporeal membrane oxygenation (ECMO) in the field of lung transplantation has rapidly expanded over the past 30 years. It has become an important tool in an increasing number of specialized centers as a bridge to transplantation and in the intra-operative and/or post-operative setting. ECMO is an extremely versatile tool in the field of lung transplantation as it can be used and adapted in different configurations with several potential cannulation sites according to the specific need of the recipient. For example, patients who need to be bridged to lung transplantation often have hypercapnic respiratory failure that may preferably benefit from veno-venous (VV) ECMO or peripheral veno-arterial (VA) ECMO in the case of hemodynamic instability. Moreover, in an intra-operative setting, VV ECMO can be maintained or switched to a VA ECMO. The routine use of intra-operative ECMO and its eventual prolongation in the post-operative period has been widely investigated in recent years by several important lung transplantation centers in order to assess the graft function and its potential protective role on primary graft dysfunction and on ischemia-reperfusion injury. This review will assess the current evidence on the role of ECMO in the different phases of lung transplantation, while analyzing different studies on pre, intra- and post-operative utilization of this extracorporeal support.
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Affiliation(s)
- Eleonora Faccioli
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Stefano Terzi
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Alessandro Pangoni
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Ivan Lomangino
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Sara Rossi
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Andrea Lloret
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Giorgio Cannone
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Carlotta Marino
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Chiara Catelli
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Andrea Dell'Amore
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
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Stokes JW, Gannon WD, Bacchetta M. Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplant. Semin Respir Crit Care Med 2021; 42:380-391. [PMID: 34030201 DOI: 10.1055/s-0041-1728795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary technology capable of supporting cardiac and respiratory function in the presence of end-stage lung disease. Initial experiences using ECMO as a bridge to lung transplant (ECMO-BTLT) were characterized by high rates of ECMO-associated complications and poor posttransplant outcomes. More recently, ECMO-BTLT has garnered success in preserving patients' physiologic condition and candidacy prior to lung transplant due to technological advances and improved management. Despite recent growth, clinical practice surrounding use of ECMO-BTLT remains variable, with little data to inform optimal patient selection and management. Although many questions remain, the use of ECMO-BTLT has shown promising outcomes suggesting that ECMO-BTLT can be an effective strategy to ensure that complex and rapidly decompensating patients with end-stage lung disease can be safely transplanted with good outcomes. Further studies are needed to refine and inform practice patterns, management, and lung allocation in this high-risk and fragile patient population.
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Affiliation(s)
- John W Stokes
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Whitney D Gannon
- Departments of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew Bacchetta
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Biomedical Engineering, Vanderbilt University Medical Center, Nashville, Tennessee
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34
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Beeckmans H, Bos S, Vos R. Selection Criteria for Lung Transplantation: Controversies and New Developments. Semin Respir Crit Care Med 2021; 42:329-345. [PMID: 34030197 DOI: 10.1055/s-0041-1728756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Lung transplantation is an accepted therapeutic option for end-stage lung diseases. The imbalance between limited availability and vast need of donor organs necessitates careful selection of recipient candidates, ensuring the best possible utilization of the scarce resource of organs. Nonetheless, possible lung transplant candidates who could experience a meaningful improvement in survival and quality of life should not be excluded solely based on the complexity of their case. In this review, controversial issues or difficult limitations for lung transplantation, and new developments in recipient selection criteria, are discussed, which may help broaden recipient eligibility for lung transplantation without compromising long-term outcomes.
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Affiliation(s)
- Hanne Beeckmans
- Division of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Saskia Bos
- Division of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Robin Vos
- Division of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), BREATHE, Leuven, Belgium
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Early rehabilitation during extracorporeal membrane oxygenation has minimal impact on physiological parameters: A pilot randomised controlled trial. Aust Crit Care 2021; 34:217-225. [DOI: 10.1016/j.aucc.2020.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022] Open
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Abstract
PURPOSE OF REVIEW Over the past two decades, lung transplant has become the mainstay of treatment for several end-stage lung diseases. As the field continues to evolve, the criteria for referral and listing have also changed. The last update to these guidelines was in 2014 and several studies since then have changed how patients are transplanted. Our article aims to briefly discuss these updates in lung transplantation. RECENT FINDINGS This article discusses the importance of early referral of patients for lung transplantation and the concept of the 'transplant window'. We review the referral and listing criteria for some common pulmonary diseases and also cite the updated literature surrounding the absolute and relative contraindications keeping in mind that they are a constantly moving target. Frailty and psychosocial barriers are difficult to assess with the current assessment tools but continue to impact posttransplant outcomes. Finally, we discuss the limited data on transplantation in acute respiratory distress syndrome (ARDS) due to COVID19 as well as extracorporeal membrane oxygenation bridge to transplantation. SUMMARY The findings discussed in this article will strongly impact, if not already, how we select candidates for lung transplantation. It also addresses some aspects of lung transplant such as frailty and ARDS, which need better assessment tools and clinical data.
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Nasir BS, Klapper J, Hartwig M. Lung Transplant from ECMO: Current Results and Predictors of Post-transplant Mortality. CURRENT TRANSPLANTATION REPORTS 2021; 8:140-150. [PMID: 33842193 PMCID: PMC8021937 DOI: 10.1007/s40472-021-00323-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 01/22/2023]
Abstract
Purpose of Review We examined data from the last 5 years describing extracorporeal life support (ECLS) as a bridge to lung transplantation. We assessed predictors of survival to transplantation and post-transplant mortality. Recent Findings The number of lung transplants performed worldwide is increasing. This is accompanied by an increase in the type of patients being transplanted, including sicker patients with more advanced disease. Consequently, there is an increase in the need for bridging strategies, with varying success. Several predictors of failure have been identified. Major risk factors include retransplantation, other organ dysfunction, and deconditioning. Summary ECLS is a risky strategy but necessary for patients who would otherwise die if not bridged to transplantation. The presence of predictors for failure is not a contraindication for bridging. However, major risk factors should be approached cautiously. Other, more minor risk factors may be considered acceptable. More importantly, the strategy should be individualized for each patient to achieve the best possible outcomes.
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Affiliation(s)
- Basil S Nasir
- Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, 1000 rue Saint-Denis, Montreal, Quebec, H2X 0C1 Canada
| | - Jacob Klapper
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke Medical Center, Durham, NC USA
| | - Matthew Hartwig
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke Medical Center, Durham, NC USA
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Frailty in Lung Transplantation - Candidate Assessment and Optimization. Transplantation 2021; 105:2201-2212. [PMID: 33982913 DOI: 10.1097/tp.0000000000003671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The concept of frailty has gained considerable interest in clinical solid organ transplantation over the past decade. Frailty as a phenotypic construct to describe a patient's risk from biologic stresses, has an impact on posttransplant survival. There is keen interest in characterizing frailty in lung transplantation, both to determine which patients are suitable candidates for listing and also to prepare for their care in the aftermath of lung transplantation. Here we review the current status of research on frailty in lung transplant candidates and recipients. This review will highlight areas of uncertainty for frailty in clinical lung transplantation which are likely to impact the state-of-the-art in the field for the next decade.
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39
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Extracorporeal support to achieve lung-protective and diaphragm-protective ventilation. Curr Opin Crit Care 2020; 26:66-72. [PMID: 31876625 DOI: 10.1097/mcc.0000000000000686] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Extracorporeal support allows ultraprotective controlled and assisted ventilation, which can prevent lung and diaphragm injury. We focused on most recent findings in the application of extracorporeal support to achieve lung protection and diaphragm- protection, as well as on relevant monitoring. RECENT FINDINGS A recent randomized trial comparing the efficacy of extracorporeal support as a rescue therapy to conventional protective mechanical ventilation was stopped for futility but post hoc analyses suggested that extracorporeal support is beneficial for patients with very severe acute respiratory distress syndrome. However, the optimal ventilation settings during extracorporeal support are still debated. It is conceivable that they should enable the highest amount of CO2 removal with lowest mechanical power.Extracorporeal CO2 removal can minimize acidosis and enable the use of ultra-protective lung ventilation strategies when hypoxemia is not a major issue. Moreover, it can protect lung and diaphragm function during assisted ventilation through control of the respiratory effort.Lung mechanics, gas exchange, diaphragm electrical activity, ultrasound, electrical impedance tomography could be integrated into clinical management to define lung and diaphragm protection and guide personalized ventilation settings. SUMMARY Technological improvement and the latest evidence indicate that extracorporeal support may be an effective tool for lung and diaphragm protection.
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Swol J, Shigemura N, Ichiba S, Steinseifer U, Anraku M, Lorusso R. Artificial lungs--Where are we going with the lung replacement therapy? Artif Organs 2020; 44:1135-1149. [PMID: 33098217 DOI: 10.1111/aor.13801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022]
Abstract
Lung transplantation may be a final destination therapy in lung failure, but limited donor organ availability creates a need for alternative management, including artificial lung technology. This invited review discusses ongoing developments and future research pathways for respiratory assist devices and tissue engineering to treat advanced and refractory lung disease. An overview is also given on the aftermath of the coronavirus disease 2019 pandemic and lessons learned as the world comes out of this situation. The first order of business in the future of lung support is solving the problems with existing mechanical devices. Interestingly, challenges identified during the early days of development persist today. These challenges include device-related infection, bleeding, thrombosis, cost, and patient quality of life. The main approaches of the future directions are to repair, restore, replace, or regenerate the lungs. Engineering improvements to hollow fiber membrane gas exchangers are enabling longer term wearable systems and can be used to bridge lung failure patients to transplantation. Progress in the development of microchannel-based devices has provided the concept of biomimetic devices that may even enable intracorporeal implantation. Tissue engineering and cell-based technologies have provided the concept of bioartificial lungs with properties similar to the native organ. Recent progress in artificial lung technologies includes continued advances in both engineering and biology. The final goal is to achieve a truly implantable and durable artificial lung that is applicable to destination therapy.
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Affiliation(s)
- Justyna Swol
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Intensive Care Medicine, Paracelsus Medical University Nuremberg, General Hospital Nuremberg, Nuremberg, Germany
| | - Norihisa Shigemura
- Division of Cardiovascular Surgery, Temple University Health System Inc., Philadelphia, PA, USA
| | - Shingo Ichiba
- Department of Surgical Intensive Care Medicine, Nippon Medical School Hospital, Bunkyo-ku, Japan
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Aachen, Germany
| | - Masaki Anraku
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine Faculty of Medicine, Bunkyo-ku, Japan
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department - Heart & Vascular Centre, Maastricht University Medical Hospital, Maastricht, The Netherlands
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41
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Orozco-Hernandez EJ, Melnikoff B, Lusby M, Tallaj J, Hoopes CW. Peripheral femoral venoarterial extracorporeal membrane oxygenation as bridge to heart-lung transplant omne iter incipit primus. J Card Surg 2020; 35:2077-2080. [PMID: 32652726 DOI: 10.1111/jocs.14779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Heart-lung transplant (HLT) is a widely accepted modality for certain patients with advanced and refractory cardiopulmonary disease. Some of these patients are critically ill on the transplant waiting list, and venoarterial extracorporeal membrane oxygenation (VA-ECMO) can be used as a bridge to transplantation. Although the experience with ECMO as a bridge to lung transplant is promising, there is limited evidence to use ECMO as a bridge to HLT. Femoral cannulation remains a concern for ambulation given the risk of bleeding and cannula complications despite studies reporting its safety. We present a case of a 56-year-old male with interstitial lung disease and severe secondary pulmonary hypertension, who was successfully bridged to HLT with ambulatory femoral VA-ECMO.
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Affiliation(s)
- Erik J Orozco-Hernandez
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brett Melnikoff
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Megan Lusby
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jose Tallaj
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Charles W Hoopes
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Martin AK, Jayaraman AL, Nabzdyk CG, Wilkey BJ, Fritz AV, Kolarczyk L, Ramakrishna H. Extracorporeal Membrane Oxygenation in Lung Transplantation: Analysis of Techniques and Outcomes. J Cardiothorac Vasc Anesth 2020; 35:644-661. [PMID: 32546408 DOI: 10.1053/j.jvca.2020.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/10/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Archer Kilbourne Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Arun L Jayaraman
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Scottsdale, AZ
| | - Christoph G Nabzdyk
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Barbara J Wilkey
- Department of Anesthesiology, University of Colorado Denver, Aurora, CO
| | - Ashley Virginia Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Lavinia Kolarczyk
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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43
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Erasmus DB, Pham SM, Landolfo KP. Commentary: Rage against the machine (ventilator that is). J Thorac Cardiovasc Surg 2020; 160:1397-1398. [PMID: 32381334 DOI: 10.1016/j.jtcvs.2020.03.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Affiliation(s)
- David B Erasmus
- Department of Medicine, Mayo Clinic Florida, Jacksonville, Fla
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Fla
| | - Kevin P Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Fla.
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44
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Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation: First Polish Experience. Transplant Proc 2020; 52:2110-2112. [PMID: 32241635 DOI: 10.1016/j.transproceed.2020.02.114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/13/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Lung transplantation remains the only viable option for patients with end-stage lung diseases. However, due to an insufficient number of lung donors, many potential candidates die without undergoing the procedure. In the cases of some patients, bridges to transplantation can be implemented. One such method is extracorporeal membrane oxygenation (ECMO), which, depending on the type, has the ability to replace patients' circulatory and respiratory function. CASE PRESENTATION This case study describes 4 cases of patients, who were successfully bridged to lung transplantation. The first patient developed respiratory failure as a result of acute pulmonary embolisms. His respiratory function was insufficient and he had ECMO implanted for 84 days until he was transplanted. Another patient presented respiratory failure due to massive bleeding, which occurred during transbronchial lung biopsy. Such event led to extensive exacerbation, which resulted in using ECMO as a bridge to recovery at first, but later a bridge to lung transplantation. The patient became a lung graft recipient after 14 days on ECMO. The third patient was a woman who developed severe respiratory failure during the course of the progression of her underlying disease. She was treated with ECMO for 14 days as well, and she also underwent lung transplantation. The fourth patient was qualified for retransplantation. She was bridged to retransplantation via veno-venous ECMO. CONCLUSION ECMO can be used a bridge to lung transplantation for suitable patients even for a long period of time, given that it is maintained in accordance with the guidelines.
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Kwak J, Majewski MB, Jellish WS. Extracorporeal Membrane Oxygenation: The New Jack-of-All-Trades? J Cardiothorac Vasc Anesth 2020; 34:192-207. [DOI: 10.1053/j.jvca.2019.09.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 09/03/2019] [Accepted: 09/20/2019] [Indexed: 11/11/2022]
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Kukreja J, Tsou S, Chen J, Trinh BN, Feng C, Golden JA, Hays S, Deuse T, Singer JP, Brzezinski M. Risk Factors and Outcomes of Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation. Semin Thorac Cardiovasc Surg 2020; 32:772-785. [DOI: 10.1053/j.semtcvs.2020.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/02/2020] [Indexed: 01/25/2023]
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47
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Idiopathic Pulmonary Fibrosis and Lung Transplantation: When it is Feasible. ACTA ACUST UNITED AC 2019; 55:medicina55100702. [PMID: 31635104 PMCID: PMC6843894 DOI: 10.3390/medicina55100702] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/26/2019] [Accepted: 10/16/2019] [Indexed: 01/27/2023]
Abstract
Despite the availability of antifibrotic therapies, many patients with idiopathic pulmonary fibrosis (IPF) will progress to advanced disease and require lung transplantation. International guidelines for transplant referral and listing of patients with interstitial lung disease are not specific to those with IPF and were published before the widespread use of antifibrotic therapy. In this review, we discussed difficulties in decision-making when dealing with patients with IPF due to the wide variability in clinical course and life expectancy, as well as the acute deterioration associated with exacerbations. Indeed, the ideal timing for referral and listing for lung transplant remains challenging, and the acute deterioration might be influenced after transplant outcomes. Of note, patients with IPF are frequently affected by multimorbidity, thus a screening program for occurring conditions, such as coronary artery disease and pulmonary hypertension, before lung transplant listing is crucial to candidate selection, risk stratification, and optimal outcomes. Among several comorbidities, it is of extreme importance to highlight that the prevalence of lung cancer is increased amongst patients affected by IPF; therefore, candidates’ surveillance is critical to avoid organ allocation to unsuitable patients. For all these reasons, early referral and close longitudinal follow-up for potential lung transplant candidates are widely encouraged.
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Nam KH, Koh Y, Lim CM, Huh JW, Jung SH, Kang PJ, Lim JY, Hong SB. Central Extracorporeal Membrane Oxygenation for Bridging of Right-Sided Heart Failure to Lung Transplantation: A Single-Center Experience and Literature Review. J Cardiothorac Vasc Anesth 2019; 33:1873-1876. [DOI: 10.1053/j.jvca.2019.01.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/23/2019] [Accepted: 01/25/2019] [Indexed: 01/30/2023]
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49
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Tawil JN, Adams BA, Nicoara A, Boisen ML. Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation. Semin Cardiothorac Vasc Anesth 2019; 23:171-187. [PMID: 31064319 DOI: 10.1177/1089253219845408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Publications of note from 2018 are reviewed for the cardiothoracic transplant anesthesiologist. Strategies to expand the availability of donor organs were highlighted, including improved donor management, accumulating experience with increased-risk donors, ex vivo perfusion techniques, and donation after cardiac death. A number of reports examined posttransplant outcomes, including outcomes other than mortality, with new data-driven risk models. Use of extracorporeal support in cardiothoracic transplantation was a prominent theme. Major changes in adult heart allocation criteria were implemented, aiming to improve objectivity and transparency in the listing process. Frailty and prehabilitation emerged as targets of comprehensive perioperative risk mitigation programs.
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Affiliation(s)
| | | | | | - Michael L Boisen
- 4 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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50
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Ortoleva JP, Dalia AA, Fiedler AG, D'Alessandro D, Shelton K, Villavicencio M, Cudemus GA. Echocardiographic Assessment of Biventricular Function in 249 Patients During the Peri-Extracorporeal Membrane Oxygenation Period. J Cardiothorac Vasc Anesth 2019; 33:1325-1330. [DOI: 10.1053/j.jvca.2018.09.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Indexed: 11/11/2022]
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