Right ventricular mechanical support as a bridge to lung transplantation: A literature review of current practices
Extracorporeal life support (ECLS) serves as a bridge to lung transplantation (BTT) for patients with acute respiratory failure (ARF) or right ventricular (RV) dysfunction/failure (RVD/RVF). Proper assessment and management of RV function in BTT patients are crucial for successful outcomes. However,...
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| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-08-01
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| Series: | JHLT Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133425001119 |
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| Summary: | Extracorporeal life support (ECLS) serves as a bridge to lung transplantation (BTT) for patients with acute respiratory failure (ARF) or right ventricular (RV) dysfunction/failure (RVD/RVF). Proper assessment and management of RV function in BTT patients are crucial for successful outcomes. However, there is a lack of consensus on standardized RV assessment strategies or optimal ECLS configurations. We aim to synthesize current evidence on RVD/RVF assessment and management in BTT patients requiring ECLS, providing a foundation to aid development of standardized clinical algorithms.A scoping literature search across PubMed, Embase, Web of Science, Cochrane Library, and grey literature was performed. Inclusion criteria comprised human studies reporting on RV assessment and/or management in BTT patients. Data on patient characteristics, RV assessment methods, and ECLS strategies were extracted. A total of 280 patients were identified. Acute respiratory failure (ARF) was the most common BTT indication (40.4%), followed by RVF (33.2%) and RVD (17.9%). Echocardiography (52.5%) and right heart catheterization (43.2%) were the primary RV assessment tools. However, reporting of specific parameters of RV assessment was inconsistent. Furthermore, we report important variability of practice in ECLS strategies: VV-ECMO (38.8%) was the most common ECLS strategy, followed by VA-ECMO (31.1%), VAV-ECMO (8.2%), and OxyRVAD (13.2%). Based on our findings, bridging strategies currently lack guidance. As BTT is often confronted with dynamic changes over time, respiratory and circulatory ECLS indications may be overlapping. Therefore, a personalized patient approach is needed. We recommend implementing institutional guidelines and international standards to systematically capture this practice. |
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| ISSN: | 2950-1334 |