Extracorporeal membrane oxygenation post lung transplantation.
PURPOSE OF REVIEW: Extracorporeal membrane oxygenation (ECMO) has been employed as a management strategy to support the failing pulmonary allograft following lung transplantation. We review the indications, technical considerations, management strategies, and outcomes of using ECMO after lung transplantation. RECENT FINDINGS: ECMO is typically indicated for early pulmonary allograft failure despite optimized conventional support measures. Initiation of ECMO has been advocated early in the postoperative course (<48 h) when ventilatory requirements reach a peak inspiratory pressure of 35 cmH2O or FiO2 surpasses 60% in order to reduce oxidative stress and barotrauma from aggressive mechanical ventilation. Both veno-venous approach and dual-stage cannulation have the potential to reduce thromboembolic complications and enable patient mobilization. Key management strategies while on ECMO include minimizing sedation, pressure-controlled ventilator support minimizing FiO2, and maintaining a hypovolemic state as tolerated. Bivalruden has been proposed as an anticoagulation alternative to heparin, which may ameliorate the effects of heparin resistance or heparin-induced thrombocytopenia syndrome. Single-center series have documented successful ECMO wean in as high as 96% of patients with 30-day survival of 82% and a 1-year survival of 64%. SUMMARY: Advances in technology and management strategies continue to increase the effectiveness of ECMO in supporting the failing pulmonary allograft.
Castleberry, AW; Hartwig, MG; Whitson, BA
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