Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Transplant Proc. 2023 Apr;55(3):684-686. doi: 10.1016/j.transproceed.2023.02.023. Epub 2023 Feb 24.
Extracorporeal membrane oxygenation (ECMO) has emerged as an alternative treatment to conventional ventilation maneuvers in the nontransplantation literature to support acute respiratory distress syndrome. However, the role of ECMO in transplant is unclear, and few case reports have described using ECMO pretransplant. We discuss the successful use of veno-arteriovenous ECMO as a bridge therapy to deceased donor liver transplant (LT) in acute respiratory distress syndrome. Because the incidence of severe pulmonary complications resulting in acute respiratory distress syndrome with multiorgan failure is rare before LT, determining the usefulness of ECMO is challenging. However, in acute but reversible respiratory failure and cardiovascular failure, veno-arteriovenous ECMO provides a useful therapeutic option as a bridge for patients awaiting LT and should be considered if available even in multiorgan failure.
体外膜肺氧合 (ECMO) 在非移植文献中已成为一种替代传统通气方法的治疗方法，以支持急性呼吸窘迫综合征。然而，ECMO 在移植中的作用尚不清楚，少数病例报告描述了在移植前使用 ECMO。我们讨论了成功使用静脉-动脉-静脉 ECMO 作为桥接治疗急性呼吸窘迫综合征的 deceased donor liver transplant (LT)。因为在 LT 之前，导致急性呼吸窘迫综合征和多器官衰竭的严重肺部并发症的发生率很少，因此确定 ECMO 的有用性具有挑战性。然而，在急性但可逆转的呼吸衰竭和心血管衰竭中，静脉-动脉-静脉 ECMO 为等待 LT 的患者提供了一种有用的治疗选择，即使在多器官衰竭的情况下，如果有条件也应考虑使用。
