1
|
Beaulieu J, Vu C, Kalra S, Chahdi HO, Cousineau J, Matteau A, Mansour S, Jolicoeur EM, Jacques S, Nauche B, Podbielski R, Ferraro P, Poirier C, Potter BJ. Right Ventricular Assist Device with an Oxygenator for the Management of Combined Right Ventricular and Respiratory Failure: A Systematic Review. Can J Cardiol 2024:S0828-282X(24)00301-5. [PMID: 38604337 DOI: 10.1016/j.cjca.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Severe lung disease frequently presents with both refractory hypoxemia and right ventricular (RV) failure. OxyRVAD is an extra-corporeal membrane oxygenation (ECMO) configuration of RV bypass that also supplements gas exchange. This systematic review summarizes the available literature regarding the use of OxyRVAD in the setting of severe lung disease with associated RV failure. METHODS PubMed, Embase, and Google Scholar were queried on September 27th, 2023, for articles describing the use of an OxyRVAD configuration. The main outcome of interest was survival to ICU discharge. Data on the duration of OxyRVAD support and device-related complications were also recorded. RESULTS Of 475 identified articles, 33 were retained for analysis. Twenty-one articles were case reports and 12 were case series representing a total of 103 patients. No article provided a comparison group. Most patients (76.4%) were transitioned to OxyRVAD from another type of mechanical support. OxyRVAD was used as a bridge to transplant or curative surgery in 37.4% and as a bridge to recovery or decision in 62.6%. Thirty-one patients (30.1%) were managed with the dedicated single-access dual-lumen ProtekDuo cannula. Median time on OxyRVAD was twelve days (IQR 8-23) and survival to ICU discharge was 63.9%. Device-related complications were infrequently reported. CONCLUSION OxyRVAD support is a promising alternative for RV support when gas exchange is compromised with good ICU survival in selected cases. Comparative analyses in patients with RV failure with and without severe lung disease are needed.
Collapse
Affiliation(s)
| | - Christine Vu
- Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC
| | - Sanjog Kalra
- Interventional Cardiology, Department of Medicine, University Health Network (UHN), Toronto, ON
| | | | - Julie Cousineau
- Intensive Care Medicine, Department of Medicine, CHUM, Montréal, QC
| | - Alexis Matteau
- CHUM Research Center (CRHCUM), Montreal, QC; Interventional Cardiology, Department of Medicine, CHUM, Montréal, QC; Cardiac Intensive Care Unit, Department of Medicine, CHUM, Montréal, QC
| | - Samer Mansour
- CHUM Research Center (CRHCUM), Montreal, QC; Interventional Cardiology, Department of Medicine, CHUM, Montréal, QC; Cardiac Intensive Care Unit, Department of Medicine, CHUM, Montréal, QC
| | - E Marc Jolicoeur
- CHUM Research Center (CRHCUM), Montreal, QC; Interventional Cardiology, Department of Medicine, CHUM, Montréal, QC; Cardiac Intensive Care Unit, Department of Medicine, CHUM, Montréal, QC
| | | | - Bénédicte Nauche
- Bibliothèque du CHUM, Direction de l'enseignement et de l'Académie CHUM (DEAC), CHUM, Montréal, QC
| | - Renata Podbielski
- Bibliothèque du CHUM, Direction de l'enseignement et de l'Académie CHUM (DEAC), CHUM, Montréal, QC
| | - Pasquale Ferraro
- CHUM Research Center (CRHCUM), Montreal, QC; Thoracic Surgery, Department of Surgery, CHUM, Montréal, QC; Lung Transplant Program, CHUM, Montréal, QC
| | - Charles Poirier
- CHUM Research Center (CRHCUM), Montreal, QC; Lung Transplant Program, CHUM, Montréal, QC; Respirology, Department of Medicine, CHUM, Montréal, QC
| | - Brian J Potter
- CHUM Research Center (CRHCUM), Montreal, QC; Interventional Cardiology, Department of Medicine, CHUM, Montréal, QC; Cardiac Intensive Care Unit, Department of Medicine, CHUM, Montréal, QC.
| |
Collapse
|
2
|
Joubert K, Harano T, Pilewski J, Sanchez PG. Oxy-RVAD support for lung transplant in the absence of inferior vena cava. J Card Surg 2020; 35:3603-3605. [PMID: 32939851 DOI: 10.1111/jocs.15040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/22/2020] [Accepted: 09/06/2020] [Indexed: 11/28/2022]
Abstract
Cardiopulmonary bypass and extracorporeal membrane oxygenation are commonly used adjuncts to lung transplantation. These techniques are not without associated morbidity and mortality, and the surgeon must be aware of the possibility of aberrant anatomy that could lead to vascular injury during cannulation. In this report, we describe a patient with congenital absence of the inferior vena cava undergoing lung transplantation who required perioperative cardiopulmonary support. A percutaneous dual lumen cannula, Protek Duo, was connected in an Oxy-RVAD configuration to provide right ventricular and oxygenation support both intraoperatively and postoperatively to this patient.
Collapse
Affiliation(s)
- Kyla Joubert
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Takashi Harano
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Joseph Pilewski
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Pablo G Sanchez
- Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
3
|
Sun JY, Whitson B, Opat K, Elhassan A, Awad H, Essandoh M. Venoarterial Extracorporeal Membrane Oxygenation Use During Double-Lung Transplantation Complicated by Severe Bilateral Air Leaks: A Novel Strategy. J Cardiothorac Vasc Anesth 2019; 33:3416-3417. [PMID: 30928281 DOI: 10.1053/j.jvca.2019.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Joseph Y Sun
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Bryan Whitson
- Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Keith Opat
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Amir Elhassan
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Hamdy Awad
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Michael Essandoh
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH.
| |
Collapse
|
4
|
Ius F, Tudorache I, Warnecke G. Extracorporeal support, during and after lung transplantation: the history of an idea. J Thorac Dis 2018; 10:5131-5148. [PMID: 30233890 DOI: 10.21037/jtd.2018.07.43] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
During recent years, continuous technological innovation has provoked an increase of extracorporeal life support (ECLS) use for perioperative cardiopulmonary support in lung transplantation. Initial results were disappointing, due to ECLS-specific complications and high surgical risk of the supported patients. However, the combination of improved patient management, multidisciplinary team work and standardization of ECLS protocols has recently yielded excellent results in several case series from high-volume transplant centres. Therein, it was demonstrated that, although the prevalence of complications remains higher in supported patients, there may be no difference in long-term graft function between supported and non-supported patients. These results are important, because most of the patients who require ECLS support in lung transplantation are young and have no other chance to survive, but to be transplanted. Moreover, there is no device for "bridging to destination" therapy in lung transplantation. Of note, the evidence in favour of ECLS support in lung transplantation was never validated by randomized controlled trials, but by everyday experience at the patient bed-side. Here, we review the state-of-the-art ECLS evidence for intraoperative and postoperative cardiopulmonary support in lung transplantation.
Collapse
Affiliation(s)
- Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL/BREATH), Hannover, Germany
| |
Collapse
|