1
|
Pervaiz Butt S, Kakar V, Abdulaziz S, Razzaq N, Saleem Y, Kumar A, Ashiq F, Ghisulal P, Thrush A, Malik S, Griffin M, Amir M, Khan U, Salim A, Zoumot Z, Mydin I, Aljabery Y, Bhatnagar G, Bayrak Y, Obeso A, Ahmed U. Enhancing lung transplantation with ECMO: a comprehensive review of mechanisms, outcomes, and future considerations. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2024; 56:191-202. [PMID: 39705583 DOI: 10.1051/ject/2024023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/25/2024] [Indexed: 12/22/2024]
Abstract
BACKGROUND Lung transplantation (LTx) is a critical intervention for patients with end-stage lung disease. However, challenges such as donor organ scarcity and post-transplant complications significantly affect its success. Recent advancements in Extracorporeal Membrane Oxygenation (ECMO) have shown promise in improving the outcomes and expanding eligibility for LTx. METHODS A comprehensive literature review was conducted, focusing on studies that explore the use of ECMO in lung transplantation. A thorough search of relevant studies on ECMO and LTx was conducted using multiple scholarly databases and relevant keywords, resulting in 73 studies that met the inclusion criteria. Sources included peer-reviewed journals and clinical trial results, with emphasis on articles captured recent advancements in ECMO technology and techniques. RESULTS ECMO has been crucial in supporting patients before, during, and after LTx. It serves as a bridge to transplantation by maintaining pulmonary and circulatory stability in critically ill patients awaiting donor organs. ECMO also aids in the evaluation of marginal donor lungs and supports patients through acute post-transplant complications. Recent technological advancements have improved the safety and efficacy of ECMO, further solidifying its role in LTx. CONCLUSION In conclusion, this review underscores ECMO's critical role in enhancing outcomes across all stages of lung transplantation. Its various configurations and strategies have shown promise in stabilizing critically ill patients and improving transplant success rates. Looking ahead, it's important to gather more information about the long-term outcomes and potential complications associated with ECMO use. More research and data collection will help us understand the benefits and risks better, leading to improved decision-making and patient care in this field.
Collapse
Affiliation(s)
- Salman Pervaiz Butt
- Interim Manager Perfusion Services, Heart Vascular and Thoracic Institute, Cleveland Clinic, PO BOX 112412, Abu Dhabi, United Arab Emirates
| | - Vivek Kakar
- Director ECMO Program, Critical Care Institute, PO BOX 112412, Abu Dhabi, United Arab Emirates
| | - Salman Abdulaziz
- Consultant of Cardiovascular Critical Care, Co-Chair of ECMO Task Force, Department of Health, United Arab Emirates
| | - Nabeel Razzaq
- Clinical Perfusionist, Heart Vascular and Thoracic Institute, Cleveland Clinic, PO BOX 112412, Abu Dhabi, United Arab Emirates
| | - Yasir Saleem
- Perfusionist, All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, New Delhi 110029, India
| | - Arun Kumar
- Department Chair, Cardiothoracic Aesthesia, Anesthesiology Institute, Cleveland Clinic, PO BOX 112412, Abu Dhabi, United Arab Emirates
| | - Fazil Ashiq
- Anesthesiology Physician, Anesthesiology Institute, Cleveland Clinic, PO BOX 112412, Abu Dhabi, United Arab Emirates
| | - Praveen Ghisulal
- Critical Care Associate Staff Physician, Critical Care Institute, PO BOX 112412, Abu Dhabi, United Arab Emirates
| | - Aaron Thrush
- Physical Therapist, Critical Care Institute, PO BOX 112412, Abu Dhabi, United Arab Emirates
| | - Sadaf Malik
- Physician Assistant, Critical Care Institute, PO BOX 112412, Abu Dhabi, United Arab Emirates
| | - Mairead Griffin
- Nurse Manager, Heart Vascular and Thoracic Institute, Cleveland Clinic, PO BOX 112412, Abu Dhabi, United Arab Emirates
| | - Mahanoor Amir
- Physical Therapist, Shalimar Medical and Dental College, Shalimar Link Road, Lahore, Punjab 54000, Pakistan
| | - Umar Khan
- Critical Care Consultant, Critical Care Institute, PO BOX 112412, Abu Dhabi, United Arab Emirates
| | - Ashal Salim
- Charge Nurse, Critical Care Institute, PO BOX 112412, Abu Dhabi, United Arab Emirates
| | - Zaid Zoumot
- Department Chair Pulmonology, Pulmonology Institute, PO BOX 112412, Abu Dhabi, United Arab Emirates
| | - Izanee Mydin
- Consultant Transplant Surgeon, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, High Heaton, NE7 7DN, UK
| | - Yazan Aljabery
- Associate Staff Physician, Heart Vascular and Thoracic Institute, Cleveland Clinic, PO BOX 112412, Abu Dhabi, United Arab Emirates
| | - Gopal Bhatnagar
- Institute Chair, Heart Vascular and Thoracic Institute, Cleveland Clinic, PO BOX 112412, Abu Dhabi, United Arab Emirates
| | - Yusuf Bayrak
- Thoracic Physician, Heart Vascular and Thoracic Institute, Cleveland Clinic, PO BOX 112412, Abu Dhabi, United Arab Emirates
| | - Andres Obeso
- Thoracic Physician, Heart Vascular and Thoracic Institute, Cleveland Clinic, PO BOX 112412, Abu Dhabi, United Arab Emirates
| | - Usman Ahmed
- Departmental Chair Thoracic Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, PO BOX 112412, Abu Dhabi, United Arab Emirates
| |
Collapse
|
3
|
Miyamoto Y, Nagamine Y, Goto T, Kurahashi K. Intraoperative Venovenous Extracorporeal Membrane Oxygenation During Thoracic Surgery That Requires 1-Lung Ventilation: A Case Report. A A Pract 2018; 10:79-82. [PMID: 28968259 DOI: 10.1213/xaa.0000000000000637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report 3 cases of thoracic surgery that required 1-lung ventilation where venovenous extracorporeal membrane oxygenation was prophylactically used because severe hypoxemia and ventilatory failure were anticipated intraoperatively. The surgery was successfully completed in all 3 cases. However, we had to withdraw the extracorporeal membrane oxygenation support in 1 case because of uncontrollable hemorrhage. Venovenous extracorporeal membrane oxygenation is a feasible option when severe hypoxemia and/or ventilatory failure is anticipated during 1-lung ventilation.
Collapse
Affiliation(s)
- Yuri Miyamoto
- From the Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | | | | | | |
Collapse
|
4
|
How to minimise ventilator-induced lung injury in transplanted lungs: The role of protective ventilation and other strategies. Eur J Anaesthesiol 2016; 32:828-36. [PMID: 26148171 DOI: 10.1097/eja.0000000000000291] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung transplantation is the treatment of choice for end-stage pulmonary diseases. In order to avoid or reduce pulmonary and systemic complications, mechanical ventilator settings have an important role in each stage of lung transplantation. In this respect, the use of mechanical ventilation with a tidal volume of 6 to 8 ml kg(-1) predicted body weight, positive end-expiratory pressure of 6 to 8 cmH2O and a plateau pressure lower than 30 cmH2O has been suggested for the donor during surgery, and for the recipient both during and after surgery. For the present review, we systematically searched the PubMed database for articles published from 2000 to 2014 using the following keywords: lung transplantation, protective mechanical ventilation, lung donor, extracorporeal membrane oxygenation, recruitment manoeuvres, extracorporeal CO2 removal and noninvasive ventilation.
Collapse
|
5
|
Raleigh L, Ha R, Hill C. Extracorporeal Membrane Oxygenation Applications in Cardiac Critical Care. Semin Cardiothorac Vasc Anesth 2015; 19:342-52. [PMID: 26403786 DOI: 10.1177/1089253215607065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The use of extracorporeal membrane oxygenation therapy (ECMO) in cardiac critical care has steadily increased over the past decade. Significant improvements in the technology associated with ECMO have propagated this recent resurgence and contributed to improved patient outcomes in the fields of cardiac and transplant (heart and lung) surgery. Specifically, ECMO is being increasingly utilized as a bridge to heart and lung transplantation, as well as to ventricular assist device placement. ECMO is also employed during the administration of cardiopulmonary resuscitation, known as extracorporeal life support. In this review, we examine the recent literature regarding the applications of ECMO and also describe emerging topics involving current ECMO management strategies.
Collapse
Affiliation(s)
- Lindsay Raleigh
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Rich Ha
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Charles Hill
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| |
Collapse
|
6
|
Polastri M, Loforte A, Dell'Amore A, Nava S. Physiotherapy for Patients on Awake Extracorporeal Membrane Oxygenation: A Systematic Review. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2015; 21:203-209. [PMID: 26274362 DOI: 10.1002/pri.1644] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 04/30/2015] [Accepted: 05/24/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Extracorporeal membrane oxygenation (ECMO) is used as temporary life support in subjects with potentially reversible respiratory/cardiac failure. The principal purpose of this review was to assess the characteristics and potential advantages of physiotherapeutic interventions in subjects on awake ECMO support. METHODS Seven databases were interrogated: we searched titles, abstracts and keywords using the Medical Subject Headings terms 'extracorporeal membrane oxygenation' and 'rehabilitation' linked with the Boolean operator 'AND'. RESULTS AND CONCLUSION In total, 216 citations were retrieved. Nine citations satisfied our inclusion criteria and were subjected to full-text analysis. The numbers of patients enrolled in the included studies (most of which were case series) were low (n = 52). We found no prospective studies or randomized controlled trials. Overall, subjects on awake ECMO usually received a combination of passive and active physiotherapy, and most achieved an acceptable degree of autonomy after treatment. Emerging research in the field affords preliminary evidence supporting the safety of early mobilization and ambulation in patients on awake veno-venous ECMO support. Copyright © 2015 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Massimiliano Polastri
- Medical Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Antonino Loforte
- Department of Cardiac-Thoracic and Vascular Diseases, Cardiac Surgery and Transplantation, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Andrea Dell'Amore
- Department of Cardiac-Thoracic and Vascular Diseases, Thoracic Surgery and Transplantation, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Stefano Nava
- Department of Specialistic-Diagnostic and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| |
Collapse
|