Yang Jianbao, Xie Xinling, Li Jian, Li Yongnan, Li Bin, Wang Cheng, Jiang Peng
Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China.
Perfusion. 2024 Apr 1:2676591241242018. doi: 10.1177/02676591241242018.
In lung transplantation surgery, extracorporeal life support (ECLS) is essential for safety. Various support methods, including cardiopulmonary bypass (CPB) and off-pump techniques, are used, with extracorporeal membrane oxygenation (ECMO) gaining prominence. However, consensus on the best support strategy is lacking. This article reviews risks, benefits, and outcomes of different support strategies in lung transplantation. By consolidating knowledge, it aims to clarify selecting the most appropriate ECLS modality. A comprehensive literature review examined CPB, off-pump techniques, and ECMO outcomes in lung transplantation, including surgical results and complications. Studies, including clinical trials and observational research, focused on ECLS in lung transplantation, both retrospective and prospective, providing a broad evidence base. Selected studies were analyzed for surgical outcomes, complications, and survival rates associated with CPB, off-pump techniques, and ECMO to assess safety and effectiveness. Off-pump techniques are preferred, with ECMO increasingly vital as a bridge to transplant, overshadowing CPB. However, ECMO entails hidden risks and higher costs. While safer than CPB, optimizing ECMO postoperative use and monitoring is crucial for success. Off-pump techniques are standard, but ECMO's role is expanding. Despite advantages, careful ECMO management is crucial due to hidden risks and costs. Future research should focus on refining ECMO use and monitoring to improve outcomes, emphasizing individualized approaches for LT recipients.
在肺移植手术中，体外生命支持（ECLS）对手术安全至关重要。目前采用了多种支持方法，包括体外循环（CPB）和非体外循环技术，其中体外膜肺氧合（ECMO）的应用日益突出。然而，对于最佳支持策略尚未达成共识。本文综述了肺移植中不同支持策略的风险、益处及结果。通过整合相关知识，旨在明确如何选择最合适的ECLS模式。一项全面的文献综述研究了肺移植中CPB、非体外循环技术和ECMO的结果，包括手术结果和并发症。这些研究包括临床试验和观察性研究，聚焦于肺移植中的ECLS，有回顾性研究也有前瞻性研究，提供了广泛的证据基础。对所选研究分析了与CPB、非体外循环技术和ECMO相关的手术结果、并发症及生存率，以评估其安全性和有效性。非体外循环技术更受青睐，ECMO作为移植桥梁的作用日益重要，逐渐取代了CPB。然而，ECMO存在潜在风险且成本较高。虽然比CPB更安全，但优化ECMO术后的使用和监测对手术成功至关重要。非体外循环技术是标准术式，但ECMO的作用正在扩大。尽管有优势，但由于潜在风险和成本，谨慎管理ECMO至关重要。未来的研究应专注于优化ECMO的使用和监测以改善结果，强调针对肺移植受者的个体化方法。
