Artificial Bridge to Lung Transplantation

Patients who are potential candidates for lung transplantation might suffer from rapid deterioration of their disease which cannot be stabilized with conventional methods. For a long time, the use of extracorporeal life support (ECLS) was considered a contraindication for lung transplantation (LuTx) because of its potential side effects and reluctance to transplant patients in such a compromised condition. In recent years, several studies have shown that in selected patients bridged with ECLS, the posttransplant outcome is comparable to those without pretransplant ECLS. Use of ECLS can even lead to better survival if used as an alternative to mechanical ventilation in an awake setting. Due to technical developments and the improvements in allocation algorithms ECLS, bridging to LuTx is now a standard procedure in many centers. Improvements of the available devices and cannulation techniques allow an individualized approach according to the respiratory and hemodynamic situation of the patient as well as the anticipated duration of extracorporeal support leading to a decrease in morbidity and mortality.