ECMO utilization in lung transplantation

Extracorporeal membrane oxygenation (ECMO) is a mechanical device that supports or replaces heart and lung function. It has been implemented with increasing effectiveness as a bridge to lung transplant in lung transplant candidates who fail maximum medical management. Depending on the physiologic needs of the patient, various ECMO strategies can be implemented and modified as the patient’s clinical condition evolves. ECMO can also be used as an intraoperative adjunct to manage poorly tolerated single-lung ventilation or elevated pulmonary artery pressures. ECMO in the post-operative setting can also be used to minimize ventilator injury in the face of primary graft dysfunction (PGD) as well as to prevent development of pulmonary edema. This chapter will describe ECMO physiology and configurations along with bridge and support strategies used in lung transplantation.