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medical team closely monitors patients for these complications , striving to strike a balance between the potential benefits and risks of ECMO in each individual case [ 68 ]. Figure 3 shows a list of ECMO complications .
ECMO circuit related complications
ECMO circuit-related complications can arise during therapy . These complications include circuit occlusion or clotting , circuit leaks , pump malfunction , oxygenator dysfunction , air embolism , infection or sepsis , hemolysis , and circuit disconnection or accidental decannulation . Circuit occlusion or clotting can impede blood flow , requiring trouble shooting measures such as checking for obstructions and adjusting anticoagulation . Circuit leaks may result in air or blood ingress , necessitating thorough inspection and prompt resolution . Pump malfunction can disrupt adequate flow , and oxygenator dysfunction may affect gas exchange efficiency . Air embolism poses a risk and requires meticulous de-airing procedures . Infection or sepsis can develop , necessitating stringent aseptic techniques and appropriate antibiotic therapy . Hemolysis may occur , requiring monitoring and assessment of potential causes . Circuit disconnection or accidental decannulation demands immediate action to ensure patient safety and circuit reconnection . Proactive management and troubleshooting are crucial to address these complications and ensure optimal ECMO support [ 69 – 72 ].
Future considerations
Based on our institutional experience the way to advance the use of ECMO in pre , intra , and post-lung transplant settings , several key considerations should be addressed . These include :
Refining patient selection criteria to identify optimal candidates for ECMO support , based on predictive indicators and thresholds .
Optimizing ECMO management protocols , including standardized initiation , weaning , and troubleshooting processes , cannulation techniques , circuit configurations , anticoagulation strategies , and monitoring parameters .
Advancing ECMO technology , such as developing more efficient and user-friendly systems , improved oxygenators , centrifugal pumps , circuit materials , and integrated monitoring and remote management capabilities .
Evaluating long-term outcomes of ECMO-supported lung transplants to assess graft function , quality of life , and potential complications beyond the immediate posttransplant period .
Conducting comparative studies to determine the effectiveness of ECMO compared to alternative interventions or strategies through randomized controlled trials and large-scale observational studies .
Assessing the cost-effectiveness of ECMO in lung transplantation , including equipment , personnel , hospitalization , and long-term care costs , to optimize resource allocation .
Promoting multidisciplinary collaboration among transplant surgeons , anaesthetists , pulmonologists , intensivists , perfusionists , and other healthcare professionals for comprehensive and coordinated care .
Enhancing education and training programs to ensure competent healthcare professionals proficient in ECMO management , through comprehensive training , sharing best practices , and standardized educational curricula [ 73 ]. Addressing these considerations will contribute to further advancements in ECMO utilization in lung transplantation , improving patient outcomes and guiding future research and practice .
Conclusion
In conclusion , this review emphasizes the significant role of ECMO in improving outcomes throughout the pre- , intra , and post-lung transplant phases . The utilization of different configurations and strategies has demonstrated promising results in stabilizing critically ill patients , enhancing transplant outcomes , and increasing the likelihood of successful lung transplantation . However , there are important future considerations that must be addressed to further advance the use of ECMO in these transplant settings .
A crucial area for improvement is the need for more comprehensive knowledge regarding long-term outcomes and potential complications beyond the immediate post-transplant period . By conducting further research and collecting data in this domain , we can enhance our understanding of the benefits and risks associated with ECMO in lung transplant recipients . This knowledge will facilitate informed decision-making and optimized patient care in this rapidly evolving field .
Funding The authors received no funding to complete this research .
Conflicts of interest The authors declare no conflict of interest .
Data availability statement The research data are available on request from the authors .
Authors contributions statement
Salman Pervaiz Butt : Lead Conceptualization , Lead Data curation , Lead Supervision , Lead Formal analysis , Lead Validation , Lead Visualization , Lead Writing – original draft , Lead Writing – review & editing , Lead Methodology and Project administration .
Vivek Kakar : Support Writing , review & editing , Supporting Formal Analysis , Supporting review & editing .
Salman Abdulaziz : Support Writing , review & editing , Supporting Formal Analysis , Supporting review & editing .
Nabeel Razzaq : Support writing , Supporting review & editing , Supporting Visualization
Yasir Saleem : Support writing , review & editing , Supporting Formal Analysis , Supporting review & editing .
Arun Kumar : Support writing , review & editing , Supporting Formal Analysis , Supporting review & editing .
Fazil Ashiq : Support writing , review & editing , Supporting Formal Analysis , Supporting review & editing .