Research progress on extracorporeal membrane oxygenation as a transplantation bridge before lung transplantation
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摘要: 等待行肺移植手术治疗的终末期肺病患者，常可见病情急性加重而没有合适的供体可移植。这种情况下，体外膜肺氧合(ECMO)系统可作为移植桥梁，辅助患者等候到合适的供体，以行肺移植手术。本文旨在从置管策略、适应证及禁忌证、并发症、预后及其影响因素、伦理学争论等方面介绍ECMO作为肺移植术前移植桥梁的最新研究进展。
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表 1 ECMO桥接治疗适应证及禁忌证
Table 1. Indications and contraindications of ECMO bridge therapy
分类 指标 适应证 非高龄患者(< 45岁) 仅呼吸衰竭 有康复潜力 生命支持前已完成全部肺移植术前评估 没有其他肺移植相对禁忌证 禁忌证 高龄(>60岁) 不可逆的肺外器官衰竭 感染性休克 已较长时间使用机械通气支持 严重的动脉闭塞性疾病 经验不丰富的移植中心 一般情况差 肥胖(BMI>30 kg/m2) 肝源性血小板减少症 BMI为体质量指数 
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表 2 经ECMO桥接治疗后影响肺移植疗效的因素
Table 2. Factors influencing the outcome of lung transplantation after ECMO bridging therapy
因素 指标 有利因素 年龄 < 50岁 总胆红素水平正常或轻度升高 肺动脉压力正常或轻度升高 较低的SOFA评分(< 6分) 非侵袭性通气支持 能接受理疗(例如清醒ECMO) 不利因素 年龄>60岁 总胆红素水平>51.3 μmol/L 严重的肺动脉高压 超长时间ECMO支持(>14 d) 超长时间呼吸机支持 长时间ECMO后制动 SOFA评分>9分 ECMO后大出血、感染、终末期器官衰竭 行二次肺移植, 两次移植间隔 < 1年
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表 3 关于ECMO桥接治疗的同意及反对意见
Table 3. Consent and opposition views to ECMO bridging therapy
对ECMO桥接治疗的态度 具体意见 同意 可能对患者有利 患者家属满意 容易做出这个决定 有助于医学进步 有过类似"奇迹发生"的经验 边缘供肺使用 增加移植数量 反对 万一移植失败就是浪费供体 增加医疗负担 降低移植中心成功率 对移植团队的伦理挑战 公众接受程度 延长姑息治疗时间 提高供体分配优先级
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[1] GOTTLIEB J.Update on lung transplantation[J]. Ther Adv Respir Dis, 2008, 2(4):237-247.DOI: 10.1177/1753465808093514. [2] VALAPOUR M, LEHR CJ, SKEANS MA, et al.OPTN/SRTR 2016 annual data report:lung[J]. Am J Transplant, 2018, 18(Suppl 1):363-433.DOI: 10.1111/ajt.14562. [3] COMBES A, BRODIE D, CHEN YS, et al.The ICM research agenda on extracorporeal life support[J]. Intensive Care Med, 2017, 43(9):1306-1318.DOI: 10.1007/s00134-017-4803-3. [4] FUEHNER T, KUEHN C, WELTE T, et al.ICU care before and after lung transplantation[J]. Chest, 2016, 150(2):442-450.DOI: 10.1016/j.chest.2016.02.656. [5] FUEHNER T, KUEHN C, HADEM J, et al.Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation[J]. Am J Respir Crit Care Med, 2012, 185(7):763-768.DOI: 10.1164/rccm.201109-1599OC. [6] THIAGARAJAN RR, BARBARO RP, RYCUS PT, et al.Extracorporeal life support organization registry international report 2016[J]. ASAIO J, 2017, 63(1):60-67.DOI: 10.1097/MAT.0000000000000475. [7] LORUSSO R, BARILI F, MAURO MD, et al.In-hospital neurologic complications in adult patients undergoing venoarterial extracorporeal membrane oxygenation:results from the extracorporeal life support organization registry[J]. Crit Care Med, 2016, 44(10):e964-e972.DOI: 10.1097/CCM.0000000000001865. [8] BISDAS T, BEUTEL G, WARNECKE G, et al.Vascular complications in patients undergoing femoral cannulation for extracorporeal membrane oxygenation support[J]. Ann Thorac Surg, 2011, 92(2):626-631.DOI: 10.1016/j.athoracsur.2011.02.018. [9] JAVIDFAR J, BRODIE D, COSTA J, et al.Subclavian artery cannulation for venoarterial extracorporeal membrane oxygenation[J]. ASAIO J, 2012, 58(5):494-498.DOI: 10.1097/MAT.0b013e318268ea15. [10] PATIL NP, MOHITE PN, REED A, et al.Modified technique using Novalung as bridge to transplant in pulmonary hypertension[J]. Ann Thorac Surg, 2015, 99(2):719-721.DOI: 10.1016/j.athoracsur.2014.09.061. [11] STRUEBER M, HOEPER MM, FISCHER S, et al.Bridge to thoracic organ transplantation in patients with pulmonary arterial hypertension using a pumpless lung assist device[J]. Am J Transplant, 2009, 9(4):853-857.DOI: 10.1111/j.1600-6143.2009.02549.x. [12] HAYES D JR, WHITSON BA, BLACK SM, et al.Influence of age on survival in adult patients on extracorporeal membrane oxygenation before lung transplantation[J]. J Heart Lung Transplant, 2015, 34(6):832-838.DOI: 10.1016/j.healun.2014.12.014. [13] LEWANDOWSKI K, METZ J, DEUTSCHMANN C, et al.Incidence, severity, and mortality of acute respiratory failure in Berlin, Germany[J]. Am J Respir Crit Care Med, 1995, 151(4):1121-1125. http://cn.bing.com/academic/profile?id=3bc7157fbfcd10992d4f1db93139bbd3&encoded=0&v=paper_preview&mkt=zh-cn [14] GOTTLIEB J, SMITS J, SCHRAMM R, et al.Lung transplantation in Germany since the introduction of the lung allocation score[J]. Dtsch Arztebl Int, 2017, 114(11):179-185.DOI: 10.3238/arztebl.2017.0179. [15] BELLANI G, LAFFEY JG, PHAM T, et al.Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries[J]. JAMA, 2016, 315(8):788-800.DOI: 10.1001/jama.2016.0291. [16] TSANG V, EVANS TW, MORGAN C, et al.Heart-lung transplantation for adult respiratory distress syndrome[J]. Crit Care Med, 1991, 19(2):286-287. doi: 10.1097/00003246-199102000-00028 [17] DEMERTZIS S, HAVERICH A, ZIEMER G, et al.Successful lung transplantation for posttraumatic adult respiratory distress syndrome after extracorporeal membrane oxygenation support[J]. J Heart Lung Transplant, 1992, 11(5):1005-1007. http://cn.bing.com/academic/profile?id=583e74de50f1e9412ea3826b6cf69cc8&encoded=0&v=paper_preview&mkt=zh-cn [18] BRICHON PY, BARNOUD D, PISON C, et al.Double lung transplantation for adult respiratory distress syndrome after recombinant interleukin 2[J]. Chest, 1993, 104(2):609-610. doi: 10.1378/chest.104.2.609 [19] BISDAS T, BEUTEL G, WARNECKE G, et al.Vascular complications in patients undergoing femoral cannulation for extracorporeal membrane oxygenation support[J]. Ann Thorac Surg, 2011, 92(2):626-631.DOI: 10.1016/j.athoracsur.2011.02.018. [20] HAYANGA AJ, ABOAGYE J, ESPER S, et al.Extracorporeal membrane oxygenation as a bridge to lung transplantation in the United States:an evolving strategy in the management of rapidly advancing pulmonary disease[J]. J Thorac Cardiovasc Surg, 2015, 149(1):291-296.DOI: 10.1016/j.jtcvs.2014.08.072. [21] COMBES A, BACCHETTA M, BRODIE D, et al.Extracorporeal membrane oxygenation for respiratory failure in adults[J]. Curr Opin Crit Care, 2012, 18(1):99-104.DOI: 10.1097/MCC.0b013e32834ef412. [22] HAYANGA JA, MURPHY E, GIRGIS RE, et al.Extracorporeal membrane oxygenation as a bridge to lung transplantation in patients over age 70 years:a case report[J]. Transplant Proc, 2017, 49(1):218-220.DOI: 10.1016/j.transproceed.2016.11.025. [23] HAYANGA JW, LIRA A, ABOAGYE JK, et al.Extracorporeal membrane oxygenation as a bridge to lung transplantation:what lessons might we learn from volume and expertise?[J]. Interact Cardiovasc Thorac Surg, 2016, 22(4):406-410.DOI: 10.1093/icvts/ivv379. [24] LANG G, TAGHAVI S, AIGNER C, et al.Primary lung transplantation after bridge with extracorporeal membrane oxygenation:a plea for a shift in our paradigms for indications[J]. Transplantation, 2012, 93(7):729-736.DOI: 10.1097/TP.0b013e318246f8e1. [25] WEIG T, IRLBECK M, FREY L, et al.Parameters associated with short-and midterm survival in bridging to lung transplantation with extracorporeal membrane oxygenation[J]. Clin Transplant, 2013, 27(5):E563-E570.DOI: 10.1111/ctr.12197. [26] CROTTI S, IOTTI GA, LISSONI A, et al.Organ allocation waiting time during extracorporeal bridge to lung transplant affects outcomes[J]. Chest, 2013, 144(3):1018-1025.DOI: 10.1378/chest.12-1141. [27] RAJAGOPAL K, HOEPER MM.State of the art:bridging to lung transplantation using artificial organ support technologies[J]. J Heart Lung Transplant, 2016, 35(12):1385-1398.DOI: 10.1016/j.healun.2016.10.005. [28] BISCOTTI M, GANNON WD, AGERSTRAND C, et al.Awake extracorporeal membrane oxygenation as bridge to lung transplantation:a 9-year experience[J]. Ann Thorac Surg, 2017, 104(2):412-419.DOI: 10.1016/j.athoracsur.2016.11.056. [29] SCHECHTER MA, GANAPATHI AM, ENGLUM BR, et al.Spontaneously breathing extracorporeal membrane oxygenation support provides the optimal bridge to lung transplantation[J]. Transplantation, 2016, 100(12):2699-2704. doi: 10.1097/TP.0000000000001047 -
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