Extracorporeal Life Support in Pulmonary Hypertension: Practical Aspects

Abstract

Extracorporeal life support (ECLS), in particular veno-arterial extracorporeal membrane oxygenation, has emerged as a potentially life-saving treatment modality in patients presenting with pulmonary hypertension and right heart failure refractory to conventional treatment. Used mainly as a bridge to lung transplantation, ECLS is also being used occasionally as a bridge to recovery in patients with treatable causes of right heart failure. This review article describes indications, contraindications, techniques, and outcomes of the use of ECLS in patients with PH, focusing on practical aspects in the management of such patients.

Keywords

pulmonary hypertension - right heart failure - extracorporeal life support - extracorporeal membrane oxygenation - lung transplantation

Publication History

Article published online:
14 September 2023

• References

• 1 Biscotti M, Gannon WD, Agerstrand C. et al. Awake extracorporeal membrane oxygenation as bridge to lung transplantation: a 9-year experience. Ann Thorac Surg 2017; 104 (02) 412-419
• 2 Chiumello D, Coppola S, Froio S, Colombo A, Del Sorbo L. Extracorporeal life support as bridge to lung transplantation: a systematic review. Crit Care 2015; 19 (01) 19
• 3 Hayanga AJ, Aboagye J, Esper S. et al. Extracorporeal membrane oxygenation as a bridge to lung transplantation in the United States: an evolving strategy in the management of rapidly advancing pulmonary disease. J Thorac Cardiovasc Surg 2015; 149 (01) 291-296
• 4 Hoetzenecker K, Donahoe L, Yeung JC. et al. Extracorporeal life support as a bridge to lung transplantation-experience of a high-volume transplant center. J Thorac Cardiovasc Surg 2018; 155 (03) 1316.e1-1328.e1
• 5 Olsson KM, Simon A, Strueber M. et al. Extracorporeal membrane oxygenation in nonintubated patients as bridge to lung transplantation. Am J Transplant 2010; 10 (09) 2173-2178
• 6 Rosenzweig EB, Brodie D, Abrams DC, Agerstrand CL, Bacchetta M. Extracorporeal membrane oxygenation as a novel bridging strategy for acute right heart failure in group 1 pulmonary arterial hypertension. ASAIO J 2014; 60 (01) 129-133
• 7 Hoeper MM, Benza RL, Corris P. et al. Intensive care, right ventricular support and lung transplantation in patients with pulmonary hypertension. Eur Respir J 2019; 53 (01) 1801906
• 8 Humbert M, Kovacs G, Hoeper MM. et al; ESC/ERS Scientific Document Group. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2022; 43 (38) 3618-3731
• 9 Humbert M, Kovacs G, Hoeper MM. et al; ESC/ERS Scientific Document Group. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J 2023; 61 (01) 2200879
• 10 Hoeper MM, Tudorache I, Kühn C. et al. Extracorporeal membrane oxygenation watershed. Circulation 2014; 130 (10) 864-865
• 11 Torbic H, Hohlfelder B, Krishnan S, Tonelli AR. A review of pulmonary arterial hypertension treatment in extracorporeal membrane oxygenation: a case series of adult patients. J Cardiovasc Pharmacol Ther 2022; 27: 10 742484211069005
• 12 Rosenzweig EB, Gannon WD, Madahar P. et al. Extracorporeal life support bridge for pulmonary hypertension: a high-volume single-center experience. J Heart Lung Transplant 2019; 38 (12) 1275-1285
• 13 Khoury J, Adir Y, Gayer T, Kompanietz D, Eden A. Veno-venous extracorporeal membrane oxygenation in pulmonary arterial hypertension - bridging to recovery. Respir Med Res 2021; 80: 100848
• 14 Srivastava MC, Ramani GV, Garcia JP, Griffith BP, Uber PA, Park MH. Veno-venous extracorporeal membrane oxygenation bridging to pharmacotherapy in pulmonary arterial hypertensive crisis. J Heart Lung Transplant 2010; 29 (07) 811-813
• 15 Erlebach R, Wild LC, Seeliger B. et al. Outcomes of patients with acute respiratory failure on veno-venous extracorporeal membrane oxygenation requiring additional circulatory support by veno-venoarterial extracorporeal membrane oxygenation. Front Med (Lausanne) 2022; 9: 1000084
• 16 Kon ZN, Pasrija C, Shah A, Griffith BP, Garcia JP. Venovenous extracorporeal membrane oxygenation with atrial septostomy as a bridge to lung transplantation. Ann Thorac Surg 2016; 101 (03) 1166-1169
• 17 Shehab S, Rao S, Macdonald P. et al. Outcomes of venopulmonary arterial extracorporeal life support as temporary right ventricular support after left ventricular assist implantation. J Thorac Cardiovasc Surg 2018; 156 (06) 2143-2152
• 18 de Perrot M, Granton JT, McRae K. et al. Impact of extracorporeal life support on outcome in patients with idiopathic pulmonary arterial hypertension awaiting lung transplantation. J Heart Lung Transplant 2011; 30 (09) 997-1002
• 19 Patil NP, Mohite PN, Reed A, Popov AF, Simon AR. Modified technique using Novalung as bridge to transplant in pulmonary hypertension. Ann Thorac Surg 2015; 99 (02) 719-721
• 20 Balik M, Rulisek J, Flaksa M. et al. A patient with pulmonary hypertension waiting for donor lungs during the pandemic: 194 days on extracorporeal life support including 143 days on pulmonary artery to left atrium shunt. Am J Transplant 2022; 22 (08) 2094-2098
• 21 Anderson MB, Goldstein J, Milano C. et al. Benefits of a novel percutaneous ventricular assist device for right heart failure: the prospective RECOVER RIGHT study of the Impella RP device. J Heart Lung Transplant 2015; 34 (12) 1549-1560
• 22 Anderson M, Morris DL, Tang D. et al. Outcomes of patients with right ventricular failure requiring short-term hemodynamic support with the Impella RP device. J Heart Lung Transplant 2018; 37 (12) 1448-1458
• 23 Gramegna M, Beneduce A, Bertoldi LF. et al. Impella RP support in refractory right ventricular failure complicating acute myocardial infarction with unsuccessful right coronary artery revascularization. Int J Cardiol 2020; 302: 135-137
• 24 Hansen LN, Berg H, Schmidt H. et al. Percutaneous right ventricular assist device in sepsis due to right ventricular failure and pulmonary hypertension. Acta Anaesthesiol Scand 2016; 60 (10) 1470-1472
• 25 Rosenzweig EB, Chicotka S, Bacchetta M. Right ventricular assist device use in ventricular failure due to pulmonary arterial hypertension: lessons learned. J Heart Lung Transplant 2016; 35 (10) 1272-1274
• 26 Bisdas T, Beutel G, Warnecke G. et al. Vascular complications in patients undergoing femoral cannulation for extracorporeal membrane oxygenation support. Ann Thorac Surg 2011; 92 (02) 626-631
• 27 Heilmann C, Geisen U, Beyersdorf F. et al. Acquired von Willebrand syndrome in patients with extracorporeal life support (ECLS). Intensive Care Med 2012; 38 (01) 62-68
• 28 Chieffo A, Dudek D, Hassager C. et al. Joint EAPCI/ACVC expert consensus document on percutaneous ventricular assist devices. Eur Heart J Acute Cardiovasc Care 2021; 10 (05) 570-583
• 29 Walley KR. Use of central venous oxygen saturation to guide therapy. Am J Respir Crit Care Med 2011; 184 (05) 514-520
• 30 Bermudez CA, Shiose A, Esper SA. et al. Outcomes of intraoperative venoarterial extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation. Ann Thorac Surg 2014; 98 (06) 1936-1942 , discussion 1942–1943
• 31 Ius F, Aburahma K, Boethig D. et al. Long-term outcomes after intraoperative extracorporeal membrane oxygenation during lung transplantation. J Heart Lung Transplant 2020; 39 (09) 915-925
• 32 Ius F, Kuehn C, Tudorache I. et al. Lung transplantation on cardiopulmonary support: venoarterial extracorporeal membrane oxygenation outperformed cardiopulmonary bypass. J Thorac Cardiovasc Surg 2012; 144 (06) 1510-1516
• 33 Machuca TN, Collaud S, Mercier O. et al. Outcomes of intraoperative extracorporeal membrane oxygenation versus cardiopulmonary bypass for lung transplantation. J Thorac Cardiovasc Surg 2015; 149 (04) 1152-1157
• 34 Tudorache I, Sommer W, Kühn C. et al. Lung transplantation for severe pulmonary hypertension–awake extracorporeal membrane oxygenation for postoperative left ventricular remodelling. Transplantation 2015; 99 (02) 451-458
• 35 Hoetzenecker K, Schwarz S, Muckenhuber M. et al. Intraoperative extracorporeal membrane oxygenation and the possibility of postoperative prolongation improve survival in bilateral lung transplantation. J Thorac Cardiovasc Surg 2018; 155 (05) 2193-2206.e3
• 36 Guth S, Wiedenroth CB, Wollenschläger M. et al. Short-term venoarterial extracorporeal membrane oxygenation for massive endobronchial hemorrhage after pulmonary endarterectomy. J Thorac Cardiovasc Surg 2018; 155 (02) 643-649
• 37 Abdelnour-Berchtold E, Donahoe L, McRae K. et al. Central venoarterial extracorporeal membrane oxygenation as a bridge to recovery after pulmonary endarterectomy in patients with decompensated right heart failure. J Heart Lung Transplant 2022; 41 (06) 773-779
• 38 Humbert M, McLaughlin V, Gibbs JSR. et al; PULSAR Trial Investigators. Sotatercept for the treatment of pulmonary arterial hypertension. N Engl J Med 2021; 384 (13) 1204-1215
• 39 Humbert M, McLaughlin V, Gibbs JSR. et al. Sotatercept for the treatment of pulmonary arterial hypertension: PULSAR open-label extension. Eur Respir J 2023; 61 (01) 2201347
• 40 Hoeper MM, Badesch DB, Ghofrani HA. et al; STELLAR Trial Investigators. Phase 3 trial of Sotatercept for treatment of pulmonary arterial hypertension. N Engl J Med 2023; 388 (16) 1478-1490