Copyright ©The Author(s) 2021.
World J Transplant. Jul 18, 2021; 11(7): 290-302
Published online Jul 18, 2021. doi: 10.5500/wjt.v11.i7.290
Table 1 Different ECMO configurations in lung transplantation
ECMO configuration
Support provided
Patient condition
Utilizazion in LTx
VVPeripheral (double lumen cannula in the SVC via the jugular or subclavian vein or a single lumen cannula in the femoral vein or jugular and femoral veins)Only respiratoryHypoxemiaBridge to transplantation; post-operative period
VAPeripheral (femoral vessels; jugular/subclavian vein and subclavian artery)Respiratory + circulatoryHypoxemia and cardiac failureBridge to transplantation; intra-operative; post-operative period
Central (from right atrium to aorta)
VVASame as VV ECMO + an additional cannula in the subclavian arteryRespiratory + circulatorySevere right heart dysfunction with hypoxemiaBridge to transplantation; intra-operative; post-operative period
Table 2 Outcomes of the main studies on extracorporeal membrane oxygenation as a bridge to lung transplantation
Number of patients
Median duration of ECMO
Mode of ECMO
Successful bridge (%)
In-hospital mortality
1-yr survival
3-yr survival
Tipograf et al[31], 201912112 dVV (52%)ECMO site 11%59%9%88%83%
VA (43%)Renal 8.3%
VAV (2.5%)Vascular 12%
RA-LA (1.6%)Cardiac arrest 9.9%
PA-LA (0.8%)Cerebrovascular 12%
Biscotti et al[29], 20177212 dVV (62.5%)ECMO site 15.2%55.6%7.5%90.3%NR
VA (31.9%)Renal 8.3%
VAV (4.2%)Vascular 15.2%
PA-LA (1.4%)Cerebrovascular 5.5%
Hakim et al[32], 2018308 dVV (80%)Bleeding 33%87%NR85%80%
VA (16.7%)Cardiac arrest 13%
VVA (3.3%)Cannula fracture 3%
Thrombocytopenia 23%
Needing paralytics 27%
Benazzo et al[33], 20191205 dVV 34%Vascular 3.3%80%23.3%69%NR
VA 30%Cannula related 6.6%
iLA 21.7%IDC 0.8%
VAV 0.8%
Other 13.3%
Todd et al[27], 2017122 dVV 92%NR100%0%100%NR
VA 8%
Yeo et al[28], 20171917.5 dVV 79%Bleeding 26%73.7%42%57.9%NR
VA 16%Infections 10.5%
VAV 5%
Ko et al[30], 20202711 dVV 89%Bleeding 46.7%100%25.9%75%70%
VAV 7.4%Infections 26.7%
VA 3.7%Airway 13.3%
Hoetzenecker et al[34], 20187110 dVV 42.3%Cerebrovascular 4.2%88.7%NR70%63%
VA 9.9%Renal 31.7%
PA-LA 12.7%Bleeding 34.9%
Other 33.8%
Ius et al[35], 2018879 dVV 73%Bleeding 21%78%15%79%NR
VA 37%Renal 27%
Vascular 10%
Cerebrovascular 2%
Atrial fibrillation 13%
Table 3 Outcomes of the main studies on extracorporeal membrane oxygenation for intraoperative support during lung transplantation
No. of patients
Type of ECMO
PGD rates
In hospital mortality
1-yr survival
3-yr survival
Glorion et al[43], 2018103pECMO 47.5%Rethoracotomy for bleeding 21.4%72 h grade 1-2: 70.8%12.6%82.4%65%
cECMO 52.5%Chest infections 5.8%72 h grade 3: 33%
Deep vein thrombosis 18.4%
Lower limb ischemia 6.8%
Pettenuzzo et al[45], 201815NRBleeding/surgical revision 26.6%NR13.3%NRNR
Pulmonary thromboembolism 6.7%
Cardiogenic shock 13.3%
Cerebrovascular events 6.7%
Sepsis with MOF 6.7%
Deep vein thrombosis 26.7%
Hoetzenecker et al[6], 2018343cECMO 100%Revision surgery 35%72 h grade 0: 87.5%NR91%85%
Leg ischemia 0.6%72 h grade 1: 5.4%
Thromboembolic events 1.4%72 h grade 2: 3.9%
72 h grade 3: 3.3%
Cosgun et al[44], 2017134NRLymphocele 10.4%48 h or 72 h grade 2 or 3: 7.3%NR84.2%60%
Limb ischemia 0.7%
Revision for hemothorax 12%
Local bleeding 0.7%
Local infection 0.7%
Ius et al[4], 2018281NRRethoracotomy for bleeding 17.8%24 h grade 2-3: 31.3%NRNR74%
Cerebrovascular events 1.8%48 h grade 2-3: 35.2%
Vascular complications 9.6%72 h grade 2-3: 28.8%
Hoetzenecker et al[41], 2020159cECMO 100%Wound infections 8.2%Grade 0: 48.4%NR86%NR
Evacuation of hemothorax 8.2%Grade 1: 4.4%
Thromboembolic events 0%Grade 2: 3.1%
Local bleeding 0%Grade 3: 2.5%
Local infection 3.2%Ungrad: 3.1%
Dell’Amore et al[46], 202038cECMO 76%Evacuation of hemothorax 16%72 h grade 3: 16%18%76%69%
CPB 24%Acute renal failure 21%
Pneumonia 29%
Table 4 Outcomes of the main studies on prolonged or de novo secondary extracorporeal membrane oxygenation implant after lung transplantation
Number of patients
Type of post-op ECMO
Median time from LTx to secondary ECMO
Weaning of second ECMO (%)
Mulvihill et al[57], 2017107De novo 100%3 dNR
Song et al[58], 201773De novo 25%26 d50%
Prolonged 75%
Hoetzenecker et al[6], 2018123Prolonged 100%//