Review Article

Enhancing lung transplantation with ECMO: a comprehensive review of mechanisms, outcomes, and future considerations

¹ Interim Manager Perfusion Services, Heart Vascular and Thoracic Institute, Cleveland Clinic, PO BOX 112412, Abu Dhabi, United Arab Emirates
² Director ECMO Program, Critical Care Institute, PO BOX 112412, Abu Dhabi, United Arab Emirates
³ Consultant of Cardiovascular Critical Care, Co-Chair of ECMO Task Force, Department of Health, United Arab Emirates
⁴ Clinical Perfusionist, Heart Vascular and Thoracic Institute, Cleveland Clinic, PO BOX 112412, Abu Dhabi, United Arab Emirates
⁵ Perfusionist, All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, New Delhi 110029, India
⁶ Department Chair, Cardiothoracic Aesthesia, Anesthesiology Institute, Cleveland Clinic, PO BOX 112412, Abu Dhabi, United Arab Emirates
⁷ Anesthesiology Physician, Anesthesiology Institute, Cleveland Clinic, PO BOX 112412, Abu Dhabi, United Arab Emirates
⁸ Critical Care Associate Staff Physician, Critical Care Institute, PO BOX 112412, Abu Dhabi, United Arab Emirates
⁹ Physical Therapist, Critical Care Institute, PO BOX 112412, Abu Dhabi, United Arab Emirates
¹⁰ Physician Assistant, Critical Care Institute, PO BOX 112412, Abu Dhabi, United Arab Emirates
¹¹ Nurse Manager, Heart Vascular and Thoracic Institute, Cleveland Clinic, PO BOX 112412, Abu Dhabi, United Arab Emirates
¹² Physical Therapist, Shalimar Medical and Dental College, Shalimar Link Road, Lahore, Punjab 54000, Pakistan
¹³ Critical Care Consultant, Critical Care Institute, PO BOX 112412, Abu Dhabi, United Arab Emirates
¹⁴ Charge Nurse, Critical Care Institute, PO BOX 112412, Abu Dhabi, United Arab Emirates
¹⁵ Department Chair Pulmonology, Pulmonology Institute, PO BOX 112412, Abu Dhabi, United Arab Emirates
¹⁶ Consultant Transplant Surgeon, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, High Heaton, NE7 7DN, UK
¹⁷ Associate Staff Physician, Heart Vascular and Thoracic Institute, Cleveland Clinic, PO BOX 112412, Abu Dhabi, United Arab Emirates
¹⁸ Institute Chair, Heart Vascular and Thoracic Institute, Cleveland Clinic, PO BOX 112412, Abu Dhabi, United Arab Emirates
¹⁹ Thoracic Physician, Heart Vascular and Thoracic Institute, Cleveland Clinic, PO BOX 112412, Abu Dhabi, United Arab Emirates
²⁰ Departmental Chair Thoracic Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, PO BOX 112412, Abu Dhabi, United Arab Emirates

^* Corresponding author: buttsab9@hotmail.com

Received: 7 June 2024
Accepted: 25 July 2024

Abstract

Background: Lung transplantation (LTx) is a critical intervention for patients with end-stage lung disease. However, challenges such as donor organ scarcity and post-transplant complications significantly affect its success. Recent advancements in Extracorporeal Membrane Oxygenation (ECMO) have shown promise in improving the outcomes and expanding eligibility for LTx. Methods: A comprehensive literature review was conducted, focusing on studies that explore the use of ECMO in lung transplantation. A thorough search of relevant studies on ECMO and LTx was conducted using multiple scholarly databases and relevant keywords, resulting in 73 studies that met the inclusion criteria. Sources included peer-reviewed journals and clinical trial results, with emphasis on articles captured recent advancements in ECMO technology and techniques. Results: ECMO has been crucial in supporting patients before, during, and after LTx. It serves as a bridge to transplantation by maintaining pulmonary and circulatory stability in critically ill patients awaiting donor organs. ECMO also aids in the evaluation of marginal donor lungs and supports patients through acute post-transplant complications. Recent technological advancements have improved the safety and efficacy of ECMO, further solidifying its role in LTx. Conclusion: In conclusion, this review underscores ECMO's critical role in enhancing outcomes across all stages of lung transplantation. Its various configurations and strategies have shown promise in stabilizing critically ill patients and improving transplant success rates. Looking ahead, it’s important to gather more information about the long-term outcomes and potential complications associated with ECMO use. More research and data collection will help us understand the benefits and risks better, leading to improved decision-making and patient care in this field.