Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2014 Aug;6(8):1070-9.
doi: 10.3978/j.issn.2072-1439.2014.06.04.

Bridge to lung transplantation and rescue post-transplant: the expanding role of extracorporeal membrane oxygenation

Brian C Gulack  1 , Sameer A Hirji  1 , Matthew G Hartwig  1
Affiliations
Review

Bridge to lung transplantation and rescue post-transplant: the expanding role of extracorporeal membrane oxygenation

Brian C Gulack et al. J Thorac Dis. 2014 Aug.

Abstract

Over the last several decades, the growth of lung transplantation has been hindered by a much higher demand for donor lungs than can be supplied, leading to considerable waiting time and mortality among patients waiting for transplant. This has led to the search for an alternative bridging strategy in patients with end-stage lung disease. The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation as well as a rescue strategy post-transplant for primary graft dysfunction (PGD) has been studied previously, however due to initially poor outcomes, its use was not heavily instituted. In recent years, with significant improvement in technologies, several single and multi-center studies have shown promising outcomes related to the use of ECMO as a bridging strategy as well as a therapy for patients suffering from PGD post-transplant. These results have challenged our current notion on ECMO use and hence forced us to reexamine the utility, efficacy and safety of ECMO in conjunction with lung transplantation. Through this review, we will address the various aspects related to ECMO use as a bridge to lung transplantation as well as a rescue post-transplant in the treatment of PGD. We will emphasize newer technologies related to ECMO use, examine recent observational studies and randomized trials of ECMO use before and after lung transplantation, and reflect upon our own institutional experience with the use of ECMO in these difficult clinical situations.

Keywords: Lung transplantation; extracorporeal membrane oxygenation (ECMO); primary graft dysfunction (PGD).

PubMed Disclaimer

Figures

Figure 1
Figure 1
Percentage of patients on ECMO at time of transplant by year. Data obtained from the United Network for Organ Sharing (UNOS) database 1987-2013. Only patients with no previous transplant were included. ECMO, extracorporeal membrane oxygenation.
Figure 2
Figure 2
Historical points of interest in the use of ECMO as a bridge to lung transplantation. ECMO, extracorporeal membrane oxygenation.
Figure 3
Figure 3
Demonstration of a patient ambulating on VV ECMO with a dual lumen cannula in the right internal jugular vein. VV, veno-venous; ECMO, extracorporeal membrane oxygenation.
See this image and copyright information in PMC

References

    1. Yusen RD, Christie JD, Edwards LB, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Adult Lung and Heart-Lung Transplant Report---2013; focus theme: age. J Heart Lung Transplant 2013;32:965-78 - PubMed
    1. Gottlieb J.Update on lung transplantation. Ther Adv Respir Dis 2008;2:237-47 - PubMed
    1. Yusen RD, Shearon TH, Qian Y, et al. Lung transplantation in the United States, 1999-2008. Am J Transplant 2010;10:1047-68 - PubMed
    1. Egan TM, Murray S, Bustami RT, et al. Development of the new lung allocation system in the United States. Am J Transplant 2006;6:1212-27 - PubMed
    1. George TJ, Beaty CA, Kilic A, et al. Outcomes and temporal trends among high-risk patients after lung transplantation in the United States. J Heart Lung Transplant 2012;31:1182-91 - PMC - PubMed