Coster Jenalee Nicole, Loor Gabriel
Michael E. Debakey Department of Surgery, Baylor College of Medicine, Division of Cardiothoracic Surgery, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX USA.
Michael E. Debakey Department of Surgery, Baylor College of Medicine, Division of Cardiothoracic Transplantation and Circulatory Support, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX USA.
Indian J Thorac Cardiovasc Surg. 2021 Sep;37(Suppl 3):476-483. doi: 10.1007/s12055-021-01175-4. Epub 2021 Apr 27.
Lung transplantation surgeries are performed without extracorporeal life support (ECLS) by using an off-pump technique; however, in cases of hypoxemia or hemodynamic instability, intraoperative ECLS may be required. Cardiopulmonary bypass (CPB) has traditionally been the standard practice for ECLS but has been associated with an increased risk of bleeding in the perioperative period, increased transfusion requirements, prolonged postoperative intubation, and possibly primary graft dysfunction. More recently, because of the flexibility of using extracorporeal membrane oxygenation (ECMO) in bridging to transplantation and during postoperative recovery, its use has increased. CPB and ECMO each has advantages and disadvantages; however, because comparisons of CPB and ECMO have been limited to small retrospective observational and single-institution studies, more research is required to determine the superiority of one modality. In this review, we critically examine the pros and cons of performing lung transplantation surgery off-pump or by using the ECLS modalities of ECMO and CPB support during lung transplantation surgery.
肺移植手术采用非体外循环技术在无体外生命支持（ECLS）的情况下进行；然而，在出现低氧血症或血流动力学不稳定的情况下，术中可能需要使用ECLS。传统上，体外循环（CPB）一直是ECLS的标准做法，但与围手术期出血风险增加、输血需求增加、术后插管时间延长以及可能的原发性移植物功能障碍有关。最近，由于在过渡到移植和术后恢复过程中使用体外膜肺氧合（ECMO）具有灵活性，其使用有所增加。CPB和ECMO各有优缺点；然而，由于CPB和ECMO的比较仅限于小型回顾性观察性研究和单机构研究，因此需要更多研究来确定哪种方式更具优势。在本综述中，我们批判性地审视了在肺移植手术中采用非体外循环或使用ECMO和CPB支持的ECLS模式进行肺移植手术的利弊。
