Department of Cardiothoracic Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Curr Opin Organ Transplant. 2011 Oct;16(5):458-61. doi: 10.1097/MOT.0b013e32834ac7ec.
Bridging to lung transplantation remains a controversy. Individually, it may be a life-saving therapy to use ventilation and extracorporeal means for gas exchange to keep a patient alive until lung transplantation. Collectively, this may lead to a selection of patients with the worst outcome. New technologies have become available to minimize the adverse events of extracorporeal devices. This may have an impact on the indication and use of such devices and also on the outcome.
Literature of the last 3 years were reviewed for new aspects of extracorporeal gas exchange (extracorporeal membrane oxygenation, ECMO) in order to define the status quo of these therapeutic tools in bridging to lung transplantation. It was found that new oxygenator technologies as well as pump designs miniaturized ECMO systems. In addition, a variety of possibilities for specific indications were described. Recently, many programs work on concepts to use ECMO no longer in addition to mechanical ventilation, but to avoid or wean from ventilation. This situation represents a paradigm shift in the bridging strategies for lung transplantation.
Bridging to lung transplantation changes to concepts avoiding the sequels mechanical ventilation and thereby offers improvement of lung recipients prior to the transplant procedure.
桥接肺移植仍然存在争议。单独使用通气和体外气体交换手段来维持患者生命，直到进行肺移植，这可能是一种挽救生命的治疗方法。但总体而言，这可能会选择出预后最差的患者。新技术的出现使体外设备的不良事件最小化。这可能会对这些设备的适应证和使用产生影响，并影响其预后。
为了确定这些治疗工具在桥接肺移植中的现状，对过去 3 年的文献进行了回顾，以了解体外气体交换（体外膜氧合，ECMO）的新方面。结果发现，新型氧合器技术和泵设计使 ECMO 系统小型化。此外，还描述了各种特定适应证的可能性。最近，许多项目都在研究概念，不再将 ECMO 用于机械通气之外，而是用于避免或脱机通气。这种情况代表了肺移植桥接策略的范式转变。
肺移植桥接策略的概念发生了变化，避免了机械通气的后果，从而改善了肺移植受者在移植手术前的状况。
