Ambulatory Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation Walking While Waiting
Ambulatory Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation Walking While Waiting
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DOI：
10.1378/chest.14-2188
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发表时间：
2015-05-01
期刊：
影响因子：
9.6
通讯作者：
Turner, David A.
中科院分区：
文献类型：
--
作者：
Lehr, Carli J.;Zaas, David W.;Turner, David A.
自2005年实施肺分配评分（LAS）以来，等待肺移植的危重患者比例有所增加。危重病患者在等待名单的死亡率中占相当大的比例，并且已知会增加移植后并发症。这些危重患者已经成功地通过体外膜肺氧合（ECMO）过渡到肺移植，但从历史上看，这些患者需要过度镇静，不能活动，移植后功能恢复困难，死亡率高。一种解决危重患者中经常出现的失调的方法是在等待ECMO移植时实施康复和amphibia。这种性质的非卧床ECMO程序已经被开发出来，试图在肺移植前提供康复、物理治疗和最小化镇静，以改善手术和移植后的结果。使用这种新方法已报告了良好的结果，但如何以及在何处实施这种策略仍不清楚。在这篇评论中，我们回顾了目前可用的文献，在ECMO支持作为肺移植的桥梁，讨论这项技术的未来方向，并解决资源分配和区域化护理的重要问题，因为它们涉及到流动ECMO。
The proportion of critically ill patients awaiting lung transplantation has increased since the implementation of the Lung Allocation Score (LAS) in 2005. Critically ill patients comprise a sizable proportion of wait-list mortality and are known to experience increased posttransplant complications. These critically ill patients have been successfully bridged to lung transplantation with extracorporeal membrane oxygenation (ECMO), but historically these patients have required excessive sedation, been immobile, and have had difficult functional recovery in the posttransplant period and high mortality. One solution to the deconditioning often seen in critically ill patients is the implementation of rehabilitation and ambulation while awaiting transplantation on ECMO. Ambulatory ECMO programs of this nature have been developed in an attempt to provide rehabilitation, physical therapy, and minimization of sedation prior to lung transplantation to improve both surgical and posttransplant outcomes. Favorable outcomes have been reported using this novel approach, but how and where this strategy should be implemented remain unclear. In this commentary, we review the currently available literature for ambulation and rehabilitation during ECMO support as a bridge to lung transplantation, discuss future directions for this technology, and address the important issues of resource allocation and regionalization of care as they relate to ambulatory ECMO.