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Atchade E, Ren M, Jean-Baptiste S, Tran Dinh A, Tanaka S, Tashk P, Lortat-Jacob B, Assadi M, Weisenburger G, Mal H, Sénémaud JN, Castier Y, de Tymowski C, Montravers P. ECMO support as a bridge to lung transplantation is an independent risk factor for bronchial anastomotic dehiscence. BMC Pulm Med 2022; 22:482. [PMID: 36539752 PMCID: PMC9764472 DOI: 10.1186/s12890-022-02280-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Airway complications are frequent after lung transplantation (LT), as they affect up to 23% of recipients. The implication of perioperative extracorporeal membrane oxygenation (ECMO) support and haemodynamic instability has never been specifically assessed. The first aim of this study was to explore the impact of perioperative ECMO support on bronchial anastomotic dehiscence (BAD) at Day 90 after LT. METHODS This prospective observational monocentric study analysed BAD in all consecutive patients who underwent LT in the Bichat Claude Bernard Hospital, Paris, France, between January 2016 and May 2019. BAD visible on bronchial endoscopy and/or tomodensitometry was recorded. A univariate analysis was performed (Fisher's exacts and Mann-Whitney tests), followed by a multivariate analysis to assess independent risk factors for BAD during the first 90 days after LT (p < 0.05 as significant). The Paris North Hospitals Institutional Review Board approved the study. RESULTS A total of 156 patients were analysed. BAD was observed in the first 90 days in 42 (27%) patients and was the main cause of death in 22 (14%) patients. BAD occurred during the first month after surgery in 34/42 (81%) patients. ECMO support was used as a bridge to LT, during and after surgery in 9 (6%), 117 (75%) and 40 (27%) patients, respectively. On multivariate analysis, ECMO as a bridge to LT (p = 0.04) and septic shock (p = 0.01) were independent risk factors for BAD. CONCLUSION ECMO as a bridge to LT is an independent risk factor for BAD during the first 90 days after surgery. Close monitoring of bronchial conditions must be performed in these high-risk recipients.
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Affiliation(s)
- Enora Atchade
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France
| | - Mélissa Ren
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France
| | - Sylvain Jean-Baptiste
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France
| | - Alexy Tran Dinh
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France ,grid.411119.d0000 0000 8588 831XINSERM U1148, LVTS, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France ,Université de Paris, UFR Diderot, Paris, France
| | - Sébastien Tanaka
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France ,grid.11642.300000 0001 2111 2608INSERM UMR 1188, Diabète Athérothrombose Réunion Océan Indien (DéTROI), Université de La Réunion, Saint-Denis de La Réunion, France
| | - Parvine Tashk
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France
| | - Brice Lortat-Jacob
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France
| | - Maksud Assadi
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France
| | - Gaelle Weisenburger
- grid.411119.d0000 0000 8588 831XService de Pneumologie B et Transplantation Pulmonaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France
| | - Hervé Mal
- grid.411119.d0000 0000 8588 831XService de Pneumologie B et Transplantation Pulmonaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France
| | - Jean Nicolas Sénémaud
- grid.411119.d0000 0000 8588 831XService de Chirurgie Thoracique et Vasculaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France
| | - Yves Castier
- Université de Paris, UFR Diderot, Paris, France ,grid.411119.d0000 0000 8588 831XService de Chirurgie Thoracique et Vasculaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France ,grid.462432.50000 0004 4684 943XPhysiopathologie et Epidémiologie des Maladies Respiratoires, INSERM UMR 1152, Paris, France
| | - Christian de Tymowski
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France ,grid.411119.d0000 0000 8588 831XINSERM UMR 1149, Immunorecepteur et Immunopathologie Rénale, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France
| | - Philippe Montravers
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France ,Université de Paris, UFR Diderot, Paris, France ,grid.462432.50000 0004 4684 943XPhysiopathologie et Epidémiologie des Maladies Respiratoires, INSERM UMR 1152, Paris, France
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Yu TZ, Tatum RT, Saxena A, Ahmad D, Yost CC, Maynes EJ, O'Malley TJ, Massey HT, Swol J, Whitson BA, Tchantchaleishvili V. Utilization and outcomes of extracorporeal CO 2 removal (ECCO 2 R): Systematic review and meta-analysis of arterio-venous and veno-venous ECCO 2 R approaches. Artif Organs 2021; 46:763-774. [PMID: 34897748 DOI: 10.1111/aor.14130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/25/2021] [Accepted: 11/09/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Extracorporeal carbon dioxide removal (ECCO2 R) provides respiratory support to patients suffering from hypercapnic respiratory failure by utilizing an extracorporeal shunt and gas exchange membrane to remove CO2 from either the venous (VV-ECCO2 R) or arterial (AV-ECCO2 R) system before return into the venous site. AV-ECCO2 R relies on the patient's native cardiac function to generate pressures needed to deliver blood through the extracorporeal circuit. VV-ECCO2 R utilizes a mechanical pump and can be used to treat patients with inadequate native cardiac function. We sought to evaluate the existing evidence comparing the subgroups of patients supported on VV and AV-ECCO2 R devices. METHODS A literature search was performed to identify all relevant studies published between 2000 and 2019. Demographic information, medical indications, perioperative variables, and clinical outcomes were extracted for systematic review and meta-analysis. RESULTS Twenty-five studies including 826 patients were reviewed. 60% of patients (497/826) were supported on VV-ECCO2 R. The most frequent indications were acute respiratory distress syndrome (ARDS) [69%, (95%CI: 53%-82%)] and chronic obstructive pulmonary disease (COPD) [49%, (95%CI: 37%-60%)]. ICU length of stay was significantly shorter in patients supported on VV-ECCO2 R compared to AV-ECCO2 R [15 (95%CI: 7-23) vs. 42 (95%CI: 17-67) days, p = 0.05]. In-hospital mortality was not significantly different [27% (95%CI: 18%-38%) vs. 36% (95%CI: 24%-51%), p = 0.26]. CONCLUSION Both VV and AV-ECCO2 R provided clinically meaningful CO2 removal with comparable mortality.
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Affiliation(s)
- Tiffany Z Yu
- Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Robert T Tatum
- Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Abhiraj Saxena
- Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Danial Ahmad
- Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Colin C Yost
- Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Elizabeth J Maynes
- Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Thomas J O'Malley
- Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Howard T Massey
- Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Justyna Swol
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuremberg, Nuremberg, Germany
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Truong L, Youssef FA, Ajaz U, Desai S. Extracorporeal Membrane Oxygenation Used in the Treatment of Rapidly Progressive Interstitial Pneumonia in a Patient With Amyopathic Dermatomyositis and Positive Melanoma Differentiation-Associated Gene 5. J Clin Rheumatol 2021; 27:e215-e217. [PMID: 30570490 DOI: 10.1097/rhu.0000000000000934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wan X, Bian T, Ye S, Cai P, Yu Z, Zhu J, Zhang W. Extracorporeal membrane oxygenation as a bridge vs. non-bridging for lung transplantation: A systematic review and meta-analysis. Clin Transplant 2020; 35:e14157. [PMID: 33222260 DOI: 10.1111/ctr.14157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/15/2020] [Accepted: 11/08/2020] [Indexed: 11/30/2022]
Abstract
Whether extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (BTT) can achieve a similar survival to non-BTT remains controversial. We conducted this meta-analysis to compare the outcomes between ECMO BTT and non-BTT to facilitate better clinical decision-making. Seven databases were searched for eligible studies comparing ECMO BTT and non-BTT. The primary endpoints included survival, intraoperative indicators, postoperative hospitalization indicators, and postoperative complications. Nineteen studies (involving 7061 participants) were included in the final analysis. The outcomes of overall survival, overall survival rate, graft survival rate, in-hospital mortality, postoperative hospital days, postoperative intensive care unit days, postoperative ventilation time, blood transfusion volume, and postoperative complications were all better in the non-BTT group. The total mortality in ECMO bridging was 23.03%, in which the top five causes of death were right heart failure (8.03%), multiple organ failure (7.03%), bleeding (not cranial) (4.67%), cranial bleeding (3.15%), and sepsis (2.90%). In summary, Non-BTT is associated with better survival and fewer complications compared to BTT. When ECMO may be the only option, the patient and medical team need to realize the increased risk of ECMO by complications and survival.
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Affiliation(s)
- Xiaolian Wan
- Department of Respiratory and Critical Care Medicine, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Tao Bian
- Department of Respiratory and Critical Care Medicine, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - SuGao Ye
- Department of Thoracic Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Peiquan Cai
- Department of Respiratory and Critical Care Medicine, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Zhen Yu
- Department of Respiratory and Critical Care Medicine, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Jianrong Zhu
- Department of Respiratory and Critical Care Medicine, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Wenxiong Zhang
- Department of Thoracic Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
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Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease characterized by progressive lung scarring and the histological picture of usual interstitial pneumonia (UIP). It is associated with increasing cough and dyspnoea and impaired quality of life. IPF affects ∼3 million people worldwide, with incidence increasing dramatically with age. The diagnostic approach includes the exclusion of other interstitial lung diseases or overlapping conditions and depends on the identification of the UIP pattern, usually with high-resolution CT; lung biopsy might be required in some patients. The UIP pattern is predominantly bilateral, peripheral and with a basal distribution of reticular changes associated with traction bronchiectasis and clusters of subpleural cystic airspaces. The biological processes underlying IPF are thought to reflect an aberrant reparative response to repetitive alveolar epithelial injury in a genetically susceptible ageing individual, although many questions remain on how to define susceptibility. Substantial progress has been made in the understanding of the clinical management of IPF, with the availability of two pharmacotherapeutic agents, pirfenidone and nintedanib, that decrease physiological progression and likely improve progression-free survival. Current efforts are directed at identifying IPF early, potentially relying on combinations of biomarkers that include circulating factors, demographics and imaging data.
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Snell G, Reed A, Stern M, Hadjiliadis D. The evolution of lung transplantation for cystic fibrosis: A 2017 update. J Cyst Fibros 2017; 16:553-564. [DOI: 10.1016/j.jcf.2017.06.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 06/29/2017] [Accepted: 06/29/2017] [Indexed: 02/08/2023]
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Kearns SK, Hernandez OO. "Awake" Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplant. AACN Adv Crit Care 2016; 27:293-300. [PMID: 27959313 DOI: 10.4037/aacnacc2016792] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Mortality of patients awaiting lung transplant remains a significant problem as the number of patients on the waiting list far surpasses the number of donor organs available. Interest in the use of "awake" extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplant has emerged because this strategy offers several benefits over mechanical ventilation. This article provides a review of relevant literature and discusses indications and complications of awake ECMO therapy, cannulation strategies, and nursing considerations for this patient population.
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Affiliation(s)
- Sara K Kearns
- Sara K. Kearns is ECMO Specialist, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246 . Omar O. Hernandez is ECMO Specialist, Baylor University Medical Center, Dallas, Texas
| | - Omar O Hernandez
- Sara K. Kearns is ECMO Specialist, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246 . Omar O. Hernandez is ECMO Specialist, Baylor University Medical Center, Dallas, Texas
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8
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Lee H, Hwang Y, Hwang H, Park I, Kang C, Kim Y, Kim Y. Use of Extracorporeal Membrane Oxygenation Prior to Lung Transplantation Does Not Jeopardize Short-term Survival. Transplant Proc 2015; 47:2737-42. [DOI: 10.1016/j.transproceed.2015.09.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 08/20/2015] [Accepted: 09/17/2015] [Indexed: 10/22/2022]
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9
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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: 1.2] [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.
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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
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10
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Kon ZN, Dahi S, Evans CF, Byrnes KA, Bittle GJ, Wehman B, Rector RP, McCormick BM, Herr DL, Sanchez PG, Pham SM, Griffith BP. Long-Term Venovenous Extracorporeal Membrane Oxygenation Support for Acute Respiratory Distress Syndrome. Ann Thorac Surg 2015; 100:2059-63. [PMID: 26296269 DOI: 10.1016/j.athoracsur.2015.05.088] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 05/13/2015] [Accepted: 05/18/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Given substantial advances in venovenous extracorporeal membrane oxygenation (ECMO) technology, long-term support is increasingly feasible. Although the benefits of short-term ECMO as a bridge to recovery in acute respiratory distress syndrome (ARDS) are well described, the utility and outcomes of long-term support remain unclear. METHODS Patients requiring ECMO for ARDS between January 2009 and November 2012 were retrospectively reviewed and analyzed separately for those requiring ECMO support for less than 3 weeks or for 3 weeks or longer. Demographic factors, ECMO variables, and outcomes were assessed. RESULTS Fifty-five patients with ARDS received ECMO during the study period, with 11 patients requiring long-term ECMO support and a median duration of 36 (interquartile range: 24 to 68) days. Recovery was the initial goal in all patients. Pre-ECMO mechanical ventilatory support, indices of disease severity, and the ECMO cannulation strategy were similar between the two groups. Eight (73%) patients receiving long-term support were bridged to recovery, and 1 patient was bridged to transplantation after a refractory course. Eight (73%) patients receiving long-term support and 25 (57%) patients receiving short-term support survived to 30 days and hospital discharge. CONCLUSIONS Previously, long-term ECMO support was thought to be associated with unfavorable outcomes. This study, however, may provide support for the efficacy of ECMO support even for 3 weeks or more as a bridge to recovery or transplantation.
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Affiliation(s)
- Zachary N Kon
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Siamak Dahi
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Charles F Evans
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kimberly A Byrnes
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Gregory J Bittle
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Brody Wehman
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Raymond P Rector
- Perfusion Services, University of Maryland Medical Center, Baltimore, Maryland
| | - Brian M McCormick
- Perfusion Services, University of Maryland Medical Center, Baltimore, Maryland
| | - Daniel L Herr
- Department of Medicine and Program in Trauma, R Adams Cowley Shock Trauma Center, and University of Maryland School of Medicine, Baltimore, Maryland
| | - Pablo G Sanchez
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Si M Pham
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bartley P Griffith
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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Bennett SC, Beal EW, Dumond CA, Preston T, Ralston J, Pope-Harman A, Black S, Hayes Jr D, Whitson BA. Mechanical circulatory support in lung transplantation: Cardiopulmonary bypass, extracorporeal life support, and ex-vivo lung perfusion. World J Respirol 2015; 5:78-92. [DOI: 10.5320/wjr.v5.i2.78] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 03/15/2015] [Accepted: 04/20/2015] [Indexed: 02/06/2023] Open
Abstract
Lung transplant is the standard of care for patients with end-stage lung disease refractory to medical management. There is currently a critical organ shortage for lung transplantation with only 17% of offered organs being transplanted. Of those patients receiving a lung transplant, up to 25% will develop primary graft dysfunction, which is associated with an 8-fold increase in 30-d mortality. There are numerous mechanical lung assistance modalities that may be employed to help combat these challenges. We will discuss the use of mechanical lung assistance during lung transplantation, as a bridge to transplant, as a treatment for primary graft dysfunction, and finally as a means to remodel and evaluate organs deemed unsuitable for transplant, thus increasing the donor pool, improving survival to transplant, and improving overall patient survival.
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