Orlitová Michaela, Demeulenaere Bert, Van Beersel Dieter, Van Raemdonck Dirk E, Vos Robin, Ceulemans Laurens J, Rex Steffen, Godinas Laurent, Verbelen Tom, Neyrinck Arne P
Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
JHLT Open. 2025 Jun 15;9:100316. doi: 10.1016/j.jhlto.2025.100316. eCollection 2025 Aug.
Extracorporeal life support (ECLS) serves as a bridge to lung transplantation (BTT) for patients with acute respiratory failure (ARF) or right ventricular (RV) dysfunction/failure (RVD/RVF). Proper assessment and management of RV function in BTT patients are crucial for successful outcomes. However, there is a lack of consensus on standardized RV assessment strategies or optimal ECLS configurations. We aim to synthesize current evidence on RVD/RVF assessment and management in BTT patients requiring ECLS, providing a foundation to aid development of standardized clinical algorithms. A scoping literature search across PubMed, Embase, Web of Science, Cochrane Library, and grey literature was performed. Inclusion criteria comprised human studies reporting on RV assessment and/or management in BTT patients. Data on patient characteristics, RV assessment methods, and ECLS strategies were extracted. A total of 280 patients were identified. Acute respiratory failure (ARF) was the most common BTT indication (40.4%), followed by RVF (33.2%) and RVD (17.9%). Echocardiography (52.5%) and right heart catheterization (43.2%) were the primary RV assessment tools. However, reporting of specific parameters of RV assessment was inconsistent. Furthermore, we report important variability of practice in ECLS strategies: VV-ECMO (38.8%) was the most common ECLS strategy, followed by VA-ECMO (31.1%), VAV-ECMO (8.2%), and OxyRVAD (13.2%). Based on our findings, bridging strategies currently lack guidance. As BTT is often confronted with dynamic changes over time, respiratory and circulatory ECLS indications may be overlapping. Therefore, a personalized patient approach is needed. We recommend implementing institutional guidelines and international standards to systematically capture this practice.
体外生命支持（ECLS）为急性呼吸衰竭（ARF）或右心室（RV）功能障碍/衰竭（RVD/RVF）患者提供肺移植（BTT）的桥梁。正确评估和管理BTT患者的右心室功能对于取得成功的治疗结果至关重要。然而，关于标准化右心室评估策略或最佳ECLS配置，目前尚无共识。我们旨在综合目前关于需要ECLS的BTT患者RVD/RVF评估和管理的证据，为制定标准化临床算法提供基础。我们在PubMed、Embase、Web of Science、Cochrane图书馆以及灰色文献中进行了范围界定文献检索。纳入标准包括关于BTT患者右心室评估和/或管理的人体研究。提取了患者特征、右心室评估方法和ECLS策略的数据。共识别出280例患者。急性呼吸衰竭（ARF）是最常见的BTT适应证（40.4%），其次是右心室衰竭（RVF，33.2%）和右心室功能障碍（RVD，17.9%）。超声心动图（52.5%）和右心导管检查（43.2%）是主要的右心室评估工具。然而，右心室评估特定参数的报告并不一致。此外，我们报告了ECLS策略在实践中的重要差异：静脉-静脉体外膜肺氧合（VV-ECMO，38.8%）是最常见的ECLS策略，其次是静脉-动脉体外膜肺氧合（VA-ECMO，31.1%）、静脉-动脉-静脉体外膜肺氧合（VAV-ECMO，8.2%）和氧合右心室辅助装置（OxyRVAD，13.2%）。基于我们的研究结果，目前的过渡策略缺乏指导。由于BTT常随时间发生动态变化，呼吸和循环ECLS适应证可能重叠。因此，需要采取个性化的患者治疗方法。我们建议实施机构指南和国际标准，以系统地记录这种治疗方法。
