Journal of Anaesthesia & Critical Care Case Reports

Vol 5 | Issue 3 | Sep-Dec 2019 | page: 3-6  | Jumana Yusuf Haji

Authors: Jumana Yusuf Haji [1]

Address of Correspondence
Dr. Jumana Yusuf Haji,
ECMO Program Director,
Consultant Anaesthesia And Critical Care
Aster CMI Hospital, Sahakara Nagar, Bengaluru, Karnataka , India.
E-mail: drjumana.yusuf@asterhospital.com

Extracorporeal life support (ECLS) for heart/lung in a patient in cardiorespiratory failure is a highly specialized technique which needs careful patient selection, resources, infrastructure and interdisciplinary expertise much like a transplant program. The aim of this editorial is to outline the scope of Extracorporeal membrane oxygenator (ECMO) in preoperative bridging and perioperative management of sick patients with organ failure awaiting transplant as well as post-transplant. The attempt is to collate data of international and national experience for reference. ECMO is a validated tool as a bridge to heart or lung transplant if the patients decompensate while awaiting a transplant. The method, timing of initiation and end objectives of ECMO in these patients is not
the same as that for conventional patients with sudden onset heart lung failure. Of greater challenge is the role of ECMO in liver transplant recipient perioperatively as it is definitely not a bridge to liver transplant. However, with careful selection and in ideal candidates ECMO can be used to stabilize a patient with liver failure or chronic liver disease who may otherwise be deemed too sick to transplant.

References

1. Langer et al “Awake” extracorporeal membrane oxygenation (ECMO): pathophysiology, technical considerations, and clinical pioneering. Critical Care (2016) 20:150
2. Mori M1, McCloskey G2.ASAIO J.Improving Outcomes in INTERMACS Category 1 Patients with Pre-LVAD, Awake Venous-Arterial Extracorporeal Membrane Oxygenation Support. 2019 Nov/Dec;65(8):819-826
3. Christian A. Bermudez1 , D. Michael McMullan2 Extracorporeal life support in preoperative and postoperative heart transplant management Annals of Translational Medicine, Vol 5, No 20 October 2017
4. Auzinger, G et al. “Extracorporeal membrane oxygenation before and after adult liver transplantation: worth the effort?.” Critical Care vol. 18,Suppl 1 (2014): P203. doi:10.1186/cc13393
5. D. Nayyar1, H. S. J. Man2,3 et al,*Proposed Management Algorithm for Severe Hypoxemia After Liver Transplantation in the Hepatopulmonary American Journal of Transplantation 2015; 15: 903–913
6. Monsel, A., Mal, H., Brisson, H. et al. Extracorporeal membrane oxygenation as a bridge to liver transplantation for acute respiratory distress syndrome-induced lifethreatening hypoxaemia aggravated by hepatopulmonary syndrome. Crit Care 15, R234 (2011) doi:10.1186/cc10476
7. Fleming, Geoffrey M et al. “Hepatopulmonary syndrome: use of extracorporeal life support for life-threatening hypoxia following liver transplantation.” Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society vol. 14,7 (2008): 966-70. doi:10.1002/lt.21477
8. Sun, Xiaodong et al. “Utilization of extracorporeal membrane oxygenation for a severe cardiocirculatory dysfunction recipient in liver transplantation: A case report.” Medicine vol. 97,37 (2018):e12407
9. Martucci G, Burgio G, Lullo F, et al. Veno-arterial extracorporeal membrane oxygenation as an intraoperative rescue option in case of portopulmonary hypertension recognized during liver transplantation. Minerva Anestesiol
2017;83:1336–7.
10. Wiklund L, Haraldsson A, et al.Extracorporeal membrane oxygenation as a bridge to lung transplantation in a patient with persistent severe porto-pulmonary arterial hypertension following liver transplantation. Eur J Cardiothorac Surg. 2011 May; 39(5):777-8.
11. Kyo Won Lee, Chan Woo Cho, et al Extracorporeal membrane oxygenation support for refractory septic shock in liver transplantation recipients [Ann Surg Treat Res 2017;93(3):152-158]
12. Kumar L Dr1, Varghese R1,et alExtracorporeal membrane oxygenation for posttransplant hypoxaemia following very severe hepatopulmonary syndrome.BMJ Case Rep. 2017 Nov 1;2017.
13. Sunder T, Ramesh T P, Kumar K M, Suresh M, Singh SP, Seth S. Lung transplant: The Indian experience and suggested guidelines – Part 1 selection of the donor and recipient. J Pract Cardiovasc Sci [serial online] 2018 [cited 2020 Jan 8];4:88-95
14. Fuehner T, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med. 2012;185:763–8.
15. Crotti S, et al. Organ allocation waiting time during extracorporeal bridge to lung transplant affects outcomes. Chest. 2013;144:1018–25.
16. Olsson KM, et al. Extracorporeal membrane oxygenation in nonintubated patients as bridge to lung transplantation. Am J Transplant. 2010;10:2173–8.
17 Javidfar J, et al. Extracorporeal membrane oxygenation as a bridge to lung transplantation and recovery. J Thorac Cardiovasc Surg. 2012;144:716–21.
18. Hoopes CW,et al. Extracorporeal membrane oxygenation as a bridge to pulmonary transplantation. J Thorac Cardiovasc Surg. 2013;145:862–7.
19. Lang G, et al. Awake extracorporeal membrane oxygenation bridging for pulmonary retransplantation provides comparable results to elective retransplantation. J Heart Lung Transplant. 2014;33:1264–72.
20. Mohite PN, et al. Extracorporeal life support in “awake” patients as a bridge to lung transplant. Thorac Cardiovasc Surg. 2015;63:699–705.
21. Inci et al. Outcome of extracorporeal membrane oxygenation as a bridge to lung transplantation: an institutional

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