What Kind of Extracorporeal Support Should I Use During Lung Transplantation?

Lung transplantation is the current standard of care for patients with end-stage lung diseases refractory to medical treatment. Over the past 30 years, the number of lung transplants has steadily grown due to refinement both in surgical technique and immunosuppressive regimens. Together with the increase of lung transplant procedures, different respiratory support modalities have gained a broadened role. Traditionally, in the field of lung transplantation, the role of extracorporeal mechanical circulatory support was focused on supporting patients with severe primary graft dysfunction in the posttransplant setting. Mechanical lung assistance such as extracorporeal membrane oxygenation (ECMO) or extracorporeal lung assistance (ECLA) has been employed either as a bridge to transplant in patients with irreversible respiratory failure, or as a rescue therapy in patients with posttransplant primary graft dysfunction. In the current clinical practice, intraoperative mechanical cardiorespiratory support during lung transplantation can be provided by Cardiopulmonary ByPass (CBP) or ECMO.