Can a Heart Recently Recovered from an Acute Pulmonary Embolism Supported by Venoarterial Extracorporeal Membrane Oxygenation be Considered for Donation?

Heart Recovery from a Brain-Dead Donor on Venoarterial Extracorporeal Membrane Oxygenation Support After Massive Pulmonary Embolism: Possibility to Maximize Organ Availability

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We appreciate the letter from Banfi et al 1 regarding our manuscript in which we reported the successful transplantation of a brain-dead donor (BDD) supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO) after cardiac arrest secondary to pulmonary embolism. 2 VA-ECMO has been shown to effectively treat massive PE associated with right ventricular (RV) failure and many patients achieve full RV recovery without additional extirpative procedures.

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Is VA-ECMO a Rescue Technique or a Treatment in Itself for High-Risk Pulmonary Embolism?

“…The poor neurological outcome following CPR in the context of PE can be explained as follows: the obstruction of the pulmonary arteries induces, on the one hand, the decrease in the effectiveness of cardiac massage, reducing the transpulmonary flow, the preload left ventricular and therefore cardiac output and cerebral perfusion, and, on the other hand, an increase in central venous pressure that induces a decrease in cerebral blood return [ 6 ], an increase in cerebral blood volume and therefore a higher intracranial pressure [ 7 ]. In parallel, PE induces a disorder of haematosis that also aggravates cerebral hypoxia [ 7 ]. Therefore, it appears essential that CPR be started immediately and that the implantation of ECMO be as rapid as possible, shortening the low-flow time to its minimum [ 8 ].…”