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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Respirol. Jul 28, 2015; 5(2): 78-92
Published online Jul 28, 2015. doi: 10.5320/wjr.v5.i2.78
Mechanical circulatory support in lung transplantation: Cardiopulmonary bypass, extracorporeal life support, and ex-vivo lung perfusion
Shaylyn C Bennett, Eliza W Beal, Curtis A Dumond, Thomas Preston, Jim Ralston, Amy Pope-Harman, Sylvester Black, Don Hayes Jr, Bryan A Whitson
Shaylyn C Bennett, Eliza W Beal, Department of Surgery, the Ohio State University Wexner Medical Center, Columbus, OH 43210-1267, United States
Curtis A Dumond, Bryan A Whitson, Division of Cardiothoracic Surgery, Department of Surgery, the Ohio State University Wexner Medical Center, Columbus, OH 43210-1267, United States
Thomas Preston, Department of Cardiovascular Perfusion and ECMO, Nationwide Children’s Hospital, Columbus, OH 43205, United States
Jim Ralston, Department of Perfusion, the Ohio State University Wexner Medical Center, Columbus, OH 43210-1267, United States
Amy Pope-Harman, Don Hayes Jr, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, the Ohio State University Wexner Medical Center, Columbus, OH 43210-1267, United States
Sylvester Black, Division of Transplantation Surgery, Department of Surgery, the Ohio State University Wexner Medical Center, Columbus, OH 43210-1267, United States
Don Hayes Jr, Department of Pediatric Pulmonology, Nationwide Children’s Hospital, Columbus, OH 43205, United States
Author contributions: Bennett SC involved in drafting, editing, and design of manuscript; Whitson BA involved in the conception, design and revision of the manuscript; all authors contributed equally to review and revision of the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bryan A Whitson, MD, PhD, Division of Cardiothoracic Surgery, Department of Surgery, the Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43210-1267, United States. bryan.whitson@osumc.edu
Telephone: +1-614-6855695 Fax: +1-614-2934726
Received: December 24, 2014
Peer-review started: December 26, 2014
First decision: January 20, 2015
Revised: March 15, 2015
Accepted: April 16, 2015
Article in press: April 20, 2015
Published online: July 28, 2015
Abstract

Lung transplant is the standard of care for patients with end-stage lung disease refractory to medical management. There is currently a critical organ shortage for lung transplantation with only 17% of offered organs being transplanted. Of those patients receiving a lung transplant, up to 25% will develop primary graft dysfunction, which is associated with an 8-fold increase in 30-d mortality. There are numerous mechanical lung assistance modalities that may be employed to help combat these challenges. We will discuss the use of mechanical lung assistance during lung transplantation, as a bridge to transplant, as a treatment for primary graft dysfunction, and finally as a means to remodel and evaluate organs deemed unsuitable for transplant, thus increasing the donor pool, improving survival to transplant, and improving overall patient survival.

Keywords: Lung transplant, Cardiopulmonary bypass, Extracorporeal membrane oxygenation, Extracorporeal life support, Extracorporeal lung assist, Interventional lung assist, Ex-vivo lung perfusion

Core tip: Numerous modalities of mechanical lung assistance may be employed throughout the course of a lung transplant patient. The use of cardiopulmonary bypass for lung transplantation is controversial and should be employed only when necessary for hemodynamic stability. Extracorporeal membrane oxygenation or extracorporeal lung assist devices improve survival to transplant as well as improve survival in patients with primary graft dysfunction. These techniques should be implemented early and appropriately according to patient factors. Ex-vivo lung perfusion has been shown to be safe in clinical trials and holds promise for increasing the donor pool and thus decreasing waiting list mortality.