Extracorporeal life support as a bridge to lung transplantation: a narrative review

Background and Objective: The utilization of extracorporeal life support (ECLS) as a bridge to lung transplantation (LTx) has rapidly expanded over recent years in highly urgent patients even though the reported outcomes in current literature are still divergent. The aim of our narrative review was to provide a comprehensive picture on the peri and post-operative outcomes of patients bridged to LTx with this device from the most updated literature in the field. Methods: The literature about ECLS bridge to LTx was searched on PubMed using a formal strategy. We focused our research on studies published between 2015 and 2022 and in English language. Abstract, case reports, conference presentations, editorials, expert opinions and review articles were excluded.Key content and Findings: ECLS has emerged as a valid tool to bridge critically ill patients to LTx. Some issues, like the selection of candidates and the post-operative outcomes, are still matter of debate in the current reported series. We analyzed 14 papers published in the last seven years and with at least 20 patients to provide an updated overview on this topic. We found that, in highly experienced centers, ECLS can be used as good strategy to allow critically ill patients to remain eligible to LTx with satisfying post-operative outcomes.Conclusions: Specific scores and algorithms should be implemented to improve the selection process of candidates who could benefit more from ECLS as a bridge to LTx. Ambulatory/awake ECLS strategies should be always preferred to enroll patients in active rehabilitation programs awaiting LTx, improving short and long-term outcomes and increasing the success of LTx.