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Minerva Respiratory Medicine 2022 March;61(1):6-15

DOI: 10.23736/S2784-8477.21.01980-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Survival with lung transplantation and extracorporeal membrane oxygenation: a systematic review and meta-analysis

Hongjie ZHENG 1, 2, Dongqing YAN 1, Peijie WANG 1, Yin YIN 1, Qiwei ZHANG 1, Liang ZHANG 1, Hongsen LIANG 1, Donglei SHI 1, Liu HU 1, Wenjun MAO 3, Junhang ZHANG 1, 2, Yun LI 1

1 Department of Thoracic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China; 2 Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; 3 Department of Cardiothoracic Surgery, The Affiliated Wuxi People’ s Hospital of Nanjing Medical University, Nanjing, China



INTRODUCTION: Lung transplantation (LT) is the last resort for end-stage pulmonary diseases. Extracorporeal membrane oxygenation (ECMO) can provide oxygenation, removal of carbon dioxide and hemodynamic support; therefore, ECMO support before, during, and after LT is common because LT is often associated with refractory respiratory and circulatory failure. Whether ECMO improves the chance for the patients to survive LT has been unresolved.
EVIDENCE ACQUISITION: Studies comparing the survival of LT patients with and without ECMO were identified by searching databases. Survival, graft dysfunction, pulmonary artery pressure (PAP), complications, and bilateral LT (BLT) were compared between the ECMO group and the non-ECMO group. PubMed, Embase, Web of Knowledge and Google Scholar were reviewed from January 1, 2010, to December 31, 2020, and the following combinations were used: “extracorporeal membrane oxygenation” or “ECMO” and “lung transplantation.” The electronic search was complemented by manual searching of the reference lists of retrieved studies and gray literature (such as unpublished literature).
EVIDENCE SYNTHESIS: Twelve full-text retrospective studies, including 3064 cases (ECMO: 799, non-ECMO: 2265), were identified. Overall survival improved over time and center volume and did not differ significantly between the two groups. Seventy-two-hour primary graft dysfunction (PGD) and chronic lung allograft dysfunction (CLAD) did not differ between the two groups. ECMO was used more frequently in BLT patients and patients with higher PAP. There were more complications in the ECMO group.
CONCLUSIONS: Patients who needed ECMO were in critical condition and might not have survived without ECMO. However, overall survival and graft dysfunction did not differ between the two groups, which suggests that ECMO improves the chance for the patients in critical condition to survive LT.


KEY WORDS: Lung transplantation; Extracorporeal membrane oxygenation; Survival

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