CHEST Guidelines-POINT--Should-Patients-With-Advanced-Lung-Disease- (1)

POINT--Should-Patients-With-Advanced-Lung-Disease- (1)

Pdf Summary

The debate surrounding the use of Extracorporeal Membrane Oxygenation (ECMO) as a bridge to lung transplant for patients with advanced lung disease who have not yet been listed for transplantation is complex and multidimensional. The argument for offering ECMO as a bridge to decision (ECMO-BTD) focuses on providing life-saving opportunities to patients imminently in need of a transplant but not officially listed yet. Key considerations include having access to a specialized center, a multidisciplinary consensus, and informed consent, which are crucial for deciding to apply ECMO-BTD.<br /><br />The proponents emphasize that ECMO-BTD could be appropriate for patients not clearly contravening lung transplantation criteria, thus potentially saving lives that would otherwise face a fatal prognosis. Moreover, existing evidence, while limited, suggests promising post-transplant survival for those who receive ECMO. Nevertheless, challenges such as determining patient eligibility and the potential for ECMO to lead to nowhere remain concerns, highlighting the need for careful patient selection and expert care.<br /><br />On the other hand, the counterpoint argues against using ECMO for patients not listed for a transplant, mainly due to high risks and uncertain outcomes associated with ECMO-BTT. The limitations include the lack of randomized controlled trials and poorer survival rates post-transplant in facilities not specialized in high ECMO and transplant volumes. Furthermore, the shortage of organ donors is a significant challenge, and focusing ECMO resources on already listed patients might be more justifiable.<br /><br />In conclusion, deciding whether to offer ECMO-BTD requires balancing risks and benefits, considering patient-specific and institutional capabilities, and employing a robust decision-making framework to maximize the potential for life-saving transplants.

Keywords

ECMO

lung transplant

advanced lung disease

bridge to decision

multidisciplinary consensus

informed consent

patient eligibility

post-transplant survival

organ donor shortage

decision-making framework