Rationale and design of The National Emphysema Treatment Trial: a prospective randomized trial of lung volume reduction surgery. The National Emphysema Treatment Trial Research Group
https://www.ncbi.nlm.nih.gov/pubmed/10593802
Landmark Article
Reference: Rationale and design of The National Emphysema Treatment Trial: a prospective randomized trial of lung volume reduction surgery. The National Emphysema Treatment Trial Research Group. Chest. 1999;116(6):1750-61.
Summary:
- Background: This was the publication that laid the foundations and rationale for selecting specific screening criteria for surgical lung volume reduction.
- Take Home: Reasoning and rationale for the clinical design of the NETT. These foundations were later incorporated into bronchoscopic lung volume reduction studies.
A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema
https://www.ncbi.nlm.nih.gov/pubmed/12759479
Landmark Article
Reference: Fishman A, Martinez F, Naunheim K, et al. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med. 2003;348(21):2059-73.
Background: Foundational study demonstrating the benefit of lung volume reduction surgery in upper lobar emphysema
PICO:
Populations:
- Patients with severe emphysema
- Post-bronchodilator TLC > 100%
- Post-bronchodilator RV ≥ 150%
- FEV1 ≤ 45%
- PaCO2 < 60 mmHg
- PaO2 ≥ 45 mmHg
- Completion of Pulmonary Rehabilitation
- Non-smoker for > 4 months
Intervention:
- Lung volume reduction surgery
Comparison:
- Maximal medical therapy without surgical or procedural interventions
Outcome:
- There was a mortality benefit with lung volume reduction surgery in selected patient populations
Take Home: In patients with upper lobe emphysema and low baseline exercise capacity, surgical lung volume reduction can have a protentional for a mortality benefit. In all comers however, there is only an improvement in exercise capacity.
Lung volume reduction surgery since the National Emphysema Treatment Trial: study of Society of Thoracic Surgeons Database
https://www.ncbi.nlm.nih.gov/pubmed/24631312
Clinical Trial
Reference: Decker MR, Leverson GE, Jaoude WA, Maloney JD. Lung volume reduction surgery since the National Emphysema Treatment Trial: study of Society of Thoracic Surgeons Database. J Thorac Cardiovasc Surg. 2014;148(6):2651-8.e1.
Background: This was a registry study reviewing real world implementation of surgical lung volume reduction
PICO:
Populations:
- Patients with severe emphysema
Intervention:
- Lung volume reduction surgery
Comparison:
Outcome:
- There was a mortality benefit with lung volume reduction surgery in selected patient populations; however, there were limited total surgeries performed nationally
Take Home: In patients with upper lobe emphysema and low baseline exercise capacity, surgical lung volume reduction can have a significant mortality benefit
Lung Volume Reduction Surgery on Extracorporeal Life Support
https://www.ncbi.nlm.nih.gov/pubmed/28109366
Case Report
Reference: Tzafos S, Collaud S, Wilhelm M, Wieser S, Weder W, Inci I. Lung Volume Reduction Surgery on Extracorporeal Life Support. Ann Thorac Surg. 2017;103(2):e115-e117.
Background: This is a case report on the safety and efficacy of lung volume reduction surgery on a patient requiring veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) support
PICO:
Populations:
- One patient with severe emphysema and respiratory failure
Intervention:
- Lung volume reduction surgery
Comparison:
Outcome:
- The patient survived and made a full recovery
Take Home: In selected patients, surgical lung volume reduction can be considered for patients on VA ECMO.
