Faccioli Eleonora, Inci Ilhan
Thoracic Surgery Unit, University Hospital of Padua, Padua, Italy.
Thoracic Surgery Unit, Klinik Hirslanden Zürich, Zurich, Switzerland.
J Thorac Dis. 2023 Sep 28;15(9):5221-5231. doi: 10.21037/jtd-22-1163. Epub 2023 Jul 28.
The utilization of extracorporeal life support (ECLS) as a bridge to lung transplantation (LTx) has rapidly expanded over recent years in highly urgent patients even though the reported outcomes in current literature are still divergent. The aim of our narrative review was to provide a comprehensive picture on the peri and post-operative outcomes of patients bridged to LTx with this device from the most updated literature in the field.
The literature about ECLS bridge to LTx was searched on PubMed using a formal strategy. We focused our research on studies published between 2015 and 2022 and in English language. Abstracts, case reports, conference presentations, editorials, expert opinions and review articles were excluded.
ECLS has emerged as a valid tool to bridge critically ill patients to LTx. Some issues, like the selection of candidates and the post-operative outcomes, are still matter of debate in the current reported series. We analyzed 14 papers published in the last seven years and with at least 20 patients to provide an updated overview on this topic. We found that, in highly experienced centers, ECLS can be used as a good strategy to allow critically ill patients to remain eligible to LTx with satisfying post-operative outcomes.
Specific scores and algorithms should be implemented to improve the selection process of candidates who could benefit more from ECLS as a bridge to LTx. Ambulatory/awake ECLS strategies should be always preferred to enroll patients in active rehabilitation programs awaiting LTx, improving short and long-term outcomes and increasing the success of LTx.
近年来，体外生命支持（ECLS）作为肺移植（LTx）的桥梁在高度紧急的患者中迅速普及，尽管目前文献报道的结果仍存在差异。我们叙述性综述的目的是根据该领域最新的文献，全面了解使用该设备过渡到LTx的患者围手术期和术后的结果。
采用正式策略在PubMed上搜索关于ECLS过渡到LTx的文献。我们的研究重点是2015年至2022年期间发表的英文研究。排除摘要、病例报告、会议报告、社论、专家意见和综述文章。
ECLS已成为将重症患者过渡到LTx的有效工具。在目前报道的系列研究中，一些问题，如候选人的选择和术后结果，仍然存在争议。我们分析了过去七年发表的14篇论文，这些论文至少纳入了20例患者，以提供关于该主题的最新概述。我们发现，在经验丰富的中心，ECLS可以作为一种很好的策略，使重症患者有资格接受LTx，并获得令人满意的术后结果。
应实施特定的评分和算法，以改进候选人的选择过程，这些候选人可能从ECLS作为LTx的桥梁中获益更多。应始终优先采用门诊/清醒ECLS策略，让患者参加等待LTx的积极康复计划，改善短期和长期结果，并提高LTx的成功率。
