Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY.
Division of Cardiovascular Surgery, Temple University Health System/Lewis Katz School of Medicine, Philadelphia, PA.
Transplantation. 2023 Jun 1;107(6):1278-1285. doi: 10.1097/TP.0000000000004606. Epub 2023 May 23.
In patients with severe acute respiratory distress syndrome caused by coronavirus 2019 (COVID-19), mortality remains high despite optimal medical management. Extracorporeal membrane oxygenation (ECMO) has been widely used to support such patients. ECMO is not a perfect solution; however, there are several limitations and serious complications associated with ECMO use. Moreover, the overall short-term mortality rate of patients with COVID-19 supported by ECMO is high (~30%). Some patients who survive severe acute respiratory distress syndrome have chronic lung failure requiring oxygen supplementation, long-term mechanical ventilation, or ECMO support. Although lung transplant remains the most effective treatment for patients with end-stage lung failure from COVID-19, optimal patient selection and transplant timing for patients with COVID-19-related lung failure are not clear. Access to an artificial lung (AL) that can be used for long-term support as a bridge to transplant, bridge to recovery, or even destination therapy will become increasingly important. In this review, we discuss why the COVID-19 pandemic may drive progress in AL technology, challenges to AL implementation, and how some of these challenges might be overcome.
在由 2019 年冠状病毒病（COVID-19）引起的严重急性呼吸窘迫综合征患者中，尽管采用了最佳的医疗管理，死亡率仍然很高。体外膜肺氧合（ECMO）已被广泛用于支持此类患者。ECMO 不是完美的解决方案；然而，ECMO 使用存在一些局限性和严重并发症。此外，接受 ECMO 支持的 COVID-19 患者的总体短期死亡率较高（约 30%）。一些从严重急性呼吸窘迫综合征中幸存下来的患者患有慢性肺衰竭，需要补充氧气、长期机械通气或 ECMO 支持。尽管肺移植仍然是治疗 COVID-19 相关终末期肺衰竭患者的最有效方法，但 COVID-19 相关肺衰竭患者的最佳患者选择和移植时机尚不清楚。获得可长期用于移植桥接、恢复桥接甚至是治疗终点的人工肺（AL）将变得越来越重要。在这篇综述中，我们讨论了为什么 COVID-19 大流行可能会推动 AL 技术的进步、AL 实施面临的挑战，以及如何克服其中的一些挑战。
