ECMO IN LUNG TRANSPLANTATION

Abstract

The use of extracorporeal membrane oxygenation (ECMO) in the field of lung transplantation has been expanding in recent years. In specialized centers, it has become an indispensable intraoperative tool, in the most severely ill patients as a bridge to transplantation, and also a great aid in postoperative management.  This tool can be adjusted and adapted in various configurations for different patient management needs. Venoarterial (V-A) or venovenous (V-V) ECMO and its mixed/hybrid derivations can provide hemodynamic and/or respiratory support in patients with advanced lung disease. For example, severe hypercapnia can be treated in the initial stages of transplantation by installing V-V ECMO and, during the clamping phase of the recipient's pulmonary artery, switching to a central V-A ECMO system, either due to instability or to protect the contralateral graft. ECMO, in addition to playing a fundamental role intraoperatively, is used in the treatment of acute postoperative complications such as primary graft dysfunction (PGD). Due to this versatility of the ECMO system and the possibility of using the device for a longer period, both preoperatively, intraoperatively, and for postoperative support, ECMO has gained this fundamental place. In this context, we will discuss ECMO and its role in lung transplantation in these three phases.