Acute Crit Care.  2022 Feb;37(1):26-34. 10.4266/acc.2022.00031.

Awakening in extracorporeal membrane oxygenation as a bridge to lung transplantation

• Lee SH

• KMID: 2527904
• DOI: http://doi.org/10.4266/acc.2022.00031

Abstract

Although the rate of lung transplantation (LTx), the last treatment option for end-stage lung disease, is increasing, some patients waiting for LTx need a bridging strategy for LTx due to the limited number of available donor lungs. For a long time, mechanical ventilation has been employed as a bridge to LTx because the outcome of using extracorporeal membrane oxygenation (ECMO) as a bridging strategy has been poor. However, the outcome after mechanical ventilation as a bridge to LTx was poor compared with that in patients without bridges. With advances in technology and the accumulation of experience, the outcome of ECMO as a bridge to LTx has improved, and the rate of ECMO use as a bridging strategy has increased over time. However, whether the use of ECMO as a bridge to LTx can achieve survival rates similar to those of non-bridged LTx patients remains controversial. In 2010, one center introduced awake ECMO strategy for LTx bridging, and its use as a bridge to LTx has been showing favorable outcomes to date. Awake ECMO has several advantages, such as maintenance of physical activity, spontaneous breathing, avoidance of endotracheal intubation, and reduced use of sedatives and analgesics, but it may cause serious problems. Nonetheless, several studies have shown that awake ECMO performed by a multidisciplinary team is safe. In cases where ECMO or mechanical ventilation is required due to unavoidable exacerbation in patients awaiting LTx, the application of awake ECMO performed by an appropriately trained ECMO multi-disciplinary team can be useful.

Keyword

critical care; extracorporeal membrane oxygenation; lung transplantation

Reference

1. Yeung JC, Keshavjee S. Overview of clinical lung transplantation. Cold Spring Harb Perspect Med. 2014; 4:a015628.

2. van der Mark SC, Hoek RA, Hellemons ME. Developments in lung transplantation over the past decade. Eur Respir Rev. 2020; 29:190132.

3. Mattar A, Chatterjee S, Loor G. Bridging to lung transplantation. Crit Care Clin. 2019; 35:11–25.

4. Hayanga JW, Hayanga HK, Holmes SD, Ren Y, Shigemura N, Badhwar V, et al. Mechanical ventilation and extracorporeal membrane oxygenation as a bridge to lung transplantation: closing the gap. J Heart Lung Transplant. 2019; 38:1104–11.

5. Langer T, Santini A, Bottino N, Crotti S, Batchinsky AI, Pesenti A, et al. “Awake” extracorporeal membrane oxygenation (ECMO): pathophysiology, technical considerations, and clinical pioneering. Crit Care. 2016; 20:150.

6. Hill JD, O’Brien TG, Murray JJ, Dontigny L, Bramson ML, Osborn JJ, et al. Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome): use of the Bramson membrane lung. N Engl J Med. 1972; 286:629–34.

7. Nelems JM, Duffin J, Glynn FX, Brebner J, Scott AA, Cooper JD. Extracorporeal membrane oxygenator support for human lung transplantation. J Thorac Cardiovasc Surg. 1978; 76:28–32.

8. The Toronto Lung Transplant group. Sequential bilateral lung transplantation for paraquat poisoning: a case report. J Thorac Cardiovasc Surg. 1985; 89:734–42.

9. Maurer JR, Frost AE, Estenne M, Higenbottam T, Glanville AR. International guidelines for the selection of lung transplant candidates. The International Society for Heart and Lung Transplantation, the American Thoracic Society, the American Society of Transplant Physicians, the European Respiratory Society. Transplantation. 1998; 66:951–6.

10. Mason DP, Thuita L, Nowicki ER, Murthy SC, Pettersson GB, Blackstone EH. Should lung transplantation be performed for patients on mechanical respiratory support?: the US experience. J Thorac Cardiovasc Surg. 2010; 139:765–73.

11. Tipograf Y, Salna M, Minko E, Grogan EL, Agerstrand C, Sonett J, et al. Outcomes of extracorporeal membrane oxygenation as a bridge to lung transplantation. Ann Thorac Surg. 2019; 107:1456–63.

12. Oto T, Rosenfeldt F, Rowland M, Pick A, Rabinov M, Preovolos A, et al. Extracorporeal membrane oxygenation after lung transplantation: evolving technique improves outcomes. Ann Thorac Surg. 2004; 78:1230–5.

13. Lafarge M, Mordant P, Thabut G, Brouchet L, Falcoz PE, Haloun A, et al. Experience of extracorporeal membrane oxygenation as a bridge to lung transplantation in France. J Heart Lung Transplant. 2013; 32:905–13.

14. Olsson KM, Simon A, Strueber M, Hadem J, Wiesner O, Gottlieb J, et al. Extracorporeal membrane oxygenation in nonintubated patients as bridge to lung transplantation. Am J Transplant. 2010; 10:2173–8.

15. Chiumello D, Coppola S, Froio S, Colombo A, Del Sorbo L. Extracorporeal life support as bridge to lung transplantation: a systematic review. Crit Care. 2015; 19:19.

16. Benazzo A, Schwarz S, Frommlet F, Schweiger T, Jaksch P, Schellongowski P, et al. Twenty-year experience with extracorporeal life support as bridge to lung transplantation. J Thorac Cardiovasc Surg. 2019; 157:2515–25.

17. Ko RE, Lee JG, Kim SY, Kim YT, Choi SM, Kim DH, et al. Extracorporeal membrane oxygenation as a bridge to lung transplantation: analysis of Korean organ transplantation registry (KOTRY) data. Respir Res. 2020; 21:20.

18. Stącel T, Urlik M, Antończyk R, Latos M, Wiklińska A, Przybyłowski P, et al. Extracorporeal membrane oxygenation as a bridge to lung transplantation: first Polish experience. Transplant Proc. 2020; 52:2110–2.

19. Biscotti M, Gannon WD, Agerstrand C, Abrams D, Sonett J, Brodie D, et al. Awake extracorporeal membrane oxygenation as bridge to lung transplantation: a 9-year experience. Ann Thorac Surg. 2017; 104:412–9.

20. Wan X, Bian T, Ye S, Cai P, Yu Z, Zhu J, et al. Extracorporeal membrane oxygenation as a bridge vs. non-bridging for lung transplantation: a systematic review and meta-analysis. Clin Transplant. 2021; 35:e14157.

21. Lang G, Kim D, Aigner C, Matila J, Taghavi S, Jaksch P, et al. Awake extracorporeal membrane oxygenation bridging for pulmonary retransplantation provides comparable results to elective retransplantation. J Heart Lung Transplant. 2014; 33:1264–72.

22. Fuehner T, Kuehn C, Hadem J, Wiesner O, Gottlieb J, Tudorache I, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med. 2012; 185:763–8.

23. Schechter MA, Ganapathi AM, Englum BR, Speicher PJ, Daneshmand MA, Davis RD, et al. Spontaneously breathing extracorporeal membrane oxygenation support provides the optimal bridge to lung transplantation. Transplantation. 2016; 100:2699–704.

24. Kim NE, Woo A, Kim SY, Leem AY, Park Y, Kwak SH, et al. Long- and short-term clinical impact of awake extracorporeal membrane oxygenation as bridging therapy for lung transplantation. Respir Res. 2021; 22:306.

25. Garcia JP, Iacono A, Kon ZN, Griffith BP. Ambulatory extracorporeal membrane oxygenation: a new approach for bridge-to-lung transplantation. J Thorac Cardiovasc Surg. 2010; 139:e137–9.

26. Kortebein P, Ferrando A, Lombeida J, Wolfe R, Evans WJ. Effect of 10 days of bed rest on skeletal muscle in healthy older adults. JAMA. 2007; 297:1772–4.

27. Dirks ML, Wall BT, van de Valk B, Holloway TM, Holloway GP, Chabowski A, et al. One week of bed rest leads to substantial muscle atrophy and induces whole-body insulin resistance in the absence of skeletal muscle lipid accumulation. Diabetes. 2016; 65:2862–75.

28. De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, et al. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002; 288:2859–67.

29. Tipping CJ, Harrold M, Holland A, Romero L, Nisbet T, Hodgson CL. The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med. 2017; 43:171–83.

30. Hume E, Ward L, Wilkinson M, Manifield J, Clark S, Vogiatzis I. Exercise training for lung transplant candidates and recipients: a systematic review. Eur Respir Rev. 2020; 29:200053.

31. Yoshida T, Amato MB, Kavanagh BP, Fujino Y. Impact of spontaneous breathing during mechanical ventilation in acute respiratory distress syndrome. Curr Opin Crit Care. 2019; 25:192–8.

32. Pehlivan E, Mutluay F, Balcı A, Kılıç L. The effects of inspiratory muscle training on exercise capacity, dyspnea and respiratory functions in lung transplantation candidates: a randomized controlled trial. Clin Rehabil. 2018; 32:1328–39.

33. Hunter JD. Ventilator associated pneumonia. BMJ. 2012; 344:e3325.

34. Lynch JP 3rd. Hospital-acquired pneumonia: risk factors, microbiology, and treatment. Chest. 2001; 119(2 Suppl):373S–384S.

35. Lee JG, Park MS, Jeong SJ, Kim SY, Na S, Kim J, et al. Critical care before lung transplantation. Acute Crit Care. 2018; 33:197–205.

36. Deng L, Xia Q, Chi C, Hu G. Awake veno-arterial extracorporeal membrane oxygenation in patients with perioperative period acute heart failure in cardiac surgery. J Thorac Dis. 2020; 12:2179–87.

37. Griesdale DE, Bosma TL, Kurth T, Isac G, Chittock DR. Complications of endotracheal intubation in the critically ill. Intensive Care Med. 2008; 34:1835–42.

38. Crotti S, Bottino N, Ruggeri GM, Spinelli E, Tubiolo D, Lissoni A, et al. Spontaneous breathing during extracorporeal membrane oxygenation in acute respiratory failure. Anesthesiology. 2017; 126:678–87.

39. Ding L, He H. Awake extracorporeal membrane oxygenation for acute respiratory distress syndrome, details to be defined: who, when, and how? Crit Care Med. 2019; 47:e1038.

40. Wells CL, Forrester J, Vogel J, Rector R, Tabatabai A, Herr D. Safety and feasibility of early physical therapy for patients on extracorporeal membrane oxygenator: University of Maryland Medical Center experience. Crit Care Med. 2018; 46:53–9.

41. Pasrija C, Mackowick KM, Raithel M, Tran D, Boulos FM, Deatrick KB, et al. Ambulation with femoral arterial cannulation can be safely performed on venoarterial extracorporeal membrane oxygenation. Ann Thorac Surg. 2019; 107:1389–94.

42. Abrams D, Garan AR, Brodie D. Awake and fully mobile patients on cardiac extracorporeal life support. Ann Cardiothorac Surg. 2019; 8:44–53.

43. Polastri M, Loforte A, Dell’Amore A, Nava S. Physiotherapy for patients on awake extracorporeal membrane oxygenation: a systematic review. Physiother Res Int. 2016; 21:203–9.

44. Eden A, Purkiss C, Cork G, Baddeley A, Morris K, Carey L, et al. In-patient physiotherapy for adults on veno-venous extracorporeal membrane oxygenation: United Kingdom ECMO Physiotherapy Network: a consensus agreement for best practice. J Intensive Care Soc. 2017; 18:212–20.

45. Rickelmann C, Knoblauch DJ. Incorporating safe patient-handling techniques to mobilize our most complex patients on extra corporeal membrane oxygenation. Crit Care Nurs Q. 2018; 41:272–81.

46. Jang MH, Shin MJ, Shin YB. Pulmonary and physical rehabilitation in critically ill patients. Acute Crit Care. 2019; 34:1–13.

47. Bear DE, Smith E, Barrett NA. Nutrition support in adult patients receiving extracorporeal membrane oxygenation. Nutr Clin Pract. 2018; 33:738–46.

48. Ohbe H, Jo T, Yamana H, Matsui H, Fushimi K, Yasunaga H. Early enteral nutrition for cardiogenic or obstructive shock requiring venoarterial extracorporeal membrane oxygenation: a nationwide inpatient database study. Intensive Care Med. 2018; 44:1258–65.

49. MacGowan L, Smith E, Elliott-Hammond C, Sanderson B, Ong D, Daly K, et al. Adequacy of nutrition support during extracorporeal membrane oxygenation. Clin Nutr. 2019; 38:324–31.

50. Patel B, Arcaro M, Chatterjee S. Bedside troubleshooting during venovenous extracorporeal membrane oxygenation (ECMO). J Thorac Dis. 2019; 11(Suppl 14):S1698–707.

51. Bunge JJ, Diaby S, Valle AL, Bakker J, Gommers D, Vincent JL, et al. Safety and efficacy of beta-blockers to improve oxygenation in patients on veno-venous ECMO. J Crit Care. 2019; 53:248–52.

52. Douflé G, Roscoe A, Billia F, Fan E. Echocardiography for adult patients supported with extracorporeal membrane oxygenation. Crit Care. 2015; 19:326.

53. Bunge JJ, Caliskan K, Gommers D, Reis Miranda D. Right ventricular dysfunction during acute respiratory distress syndrome and veno-venous extracorporeal membrane oxygenation. J Thorac Dis. 2018; 10(Suppl 5):S674–82.