Comparison of mechanical cardiopulmonary support strategies during lung transplantation

ABSTRACT

Introduction

Lung transplantation outcomes are influenced by the intraoperative mechanical cardiopulmonary support strategy used. This surgery was historically done either on cardiopulmonary bypass (CPB) or off pump. Recently, there has been increased interest in intraoperative support with veno-arterial (VA) or veno-venous (VV) extracorporeal membrane oxygenation (ECMO). However, there is a lack of consensus on the relative risks, benefits and indications for each intraoperative support strategy.

Areas covered

This review includes information from cohort studies, case-control studies, and case series that compare morbidity and/or mortality of two or more intraoperative cardiopulmonary support strategies during lung transplantation.

Expert opinion

The optimal strategy for intraoperative cardiopulmonary support during lung transplantation remains an area of debate. Current data suggest that off pump is associated with better outcomes and could be considered whenever feasible. ECMO is generally associated with preferable outcomes to CPB, but the data supporting this association is not robust. Interestingly, whether CPB is unplanned or prolonged might influence outcomes more than the use of CPB itself. These observations can help guide surgical teams in their approach for intraoperative mechanical support strategy during lung transplantation and should serve as the basis for further investigations.

KEYWORDS:

• Mechanical cardiopulmonary support
• lung transplantation
• off pump
• cardiopulmonary bypass
• extracorporeal membrane oxygenation

Article highlights

• Lung transplantation was historically done off pump or on cardiopulmonary bypass (CPB)

• Recently, there has been increased interest in using intraoperative extracorporeal membrane oxygenation (ECMO) instead of CPB

• Intraoperative ECMO and CPB are associated with primary graft dysfunction and need for postoperative mechanical cardiopulmonary support

• ECMO may have superior risk profile to CPB in terms of bleeding, acute renal failure, and early mortality

• Unplanned and prolonged CPB might be more important risk factors for morbidity than CPB itself

• No randomized control trials and few well-matched cohort studies have compared the outcomes of intraoperative ECMO and CPB for lung transplantation

• Further research is needed to establish the optimal protocol for intraoperative mechanical support during lung transplantation

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.