Extracorporeal membrane oxygenation as a bridge to lung transplantation in a Turkish lung transplantation program: our initial experience

Nurses' Interventions in Minimizing Adult Patient Vulnerability During Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation: An Integrative Review

Introduction

People during extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation find themselves in a high degree of physical and psychological vulnerability, which could cause additional problems for their health status. Therefore, this review aims to identify the interventions that shape critical nursing care to minimize patient vulnerability during ECMO as a bridge to lung transplantation.

Method

A literature review was performed using CINAHL, MEDLINE, PubMed, Scopus and Web of Science databases with searches conducted in March 2023, with temporal restriction of articles published between 2013 and 2023. After selecting articles involving adults in critical situations on ECMO, their quality was assessed using the critical appraisal tools from the Joanna Briggs Institute. Articles with the pediatric population, reviews, and opinion articles were excluded. A spreadsheet was built for data extraction and a narrative analysis was performed.

Results

Three articles were included involving 40 participants in total. Interventions that shape critical nursing care to minimize a person's vulnerability are in the physical domain (basic precautions to prevent infection) and in the psychological domain (trusting relationships, consistent and clear communication, physical presence of nurses and family members and the use of advocacy). The Awake ECMO strategy was identified as beneficial for reducing vulnerability.

Conclusion

By recognizing and identifying the person's vulnerability during ECMO as a bridge to lung transplantation, nurses can implement effective interventions to minimize vulnerability in this population, thus contributing to the person's well-being through personalization and individualization of care. Additionally, the results of this review could be useful for developing tools to assess the degree of vulnerability and for implementing person-centered care measures and policies. However, further research is warranted given the scarcity of literature on these topics.

Taking a Deep Breath: an Examination of Current Controversies in Surgical Procedures in Lung Transplantation

Purpose of Review

This article reviews controversial questions within the field of lung transplantation, with a focus on data generated within the last 3 years. We aim to summarize differing opinions on a selection of topics, including bridge-to-transplantation, intraoperative machine circulatory support, bronchial anastomosis, size mismatch, delayed chest closure, and ex vivo lung perfusion.

Recent Findings

With the growing rate of lung transplantations worldwide and increasing numbers of patients placed on waiting lists, the importance of determining best practices has only increased in recent years. Factors which promote successful outcomes have been identified across all the topics, with certain approaches promoted, such as ambulation in bridge-to-transplant and widespread intraoperative ECMO as machine support.

Summary

While great strides have been made in the operative procedures involved in lung transplantation, there are still key questions to be answered. The consensus which can be reached will be instrumental in further improving outcomes in recipients.