Extracorporeal membrane oxygenation in pediatric lung transplantation

Puri, Varun; Epstein, Deirdre J.; Raithel, Steven C.; Gandhi, Sanjiv K.; Sweet, Stuart C.; Faro, Albert; Huddleston, Charles B.

doi:10.1016/j.jtcvs.2010.04.012

Cited by 72 publications

(82 citation statements)

References 18 publications

(30 reference statements)

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“…8,16 Several small case series demonstrate the successful use of ECMO as a bridge to lung transplant, but the majority of patients are adolescents and adults with chronic lung disease who are cannulated with the intent to transplant. [4][5][6][7][8][9][10][11][12][13][14][15][16][17] Intent at the time of cannulation, based on the patient' s baseline pulmonary status, is an important consideration because data about outcomes for patients bridged to lung transplant after an initial attempt at a bridge to recovery are limited. 12 Our report describes the first pediatric patient successfully transitioned to an ambulatory ECMO bridge to lung transplant after an unsuccessful bridge to recovery.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] However, in patients with irreversible pulmonary injury, lung transplant may be necessary. Traditional outcomes for ECMO patients bridged to lung transplant are poor, [4][5][6][7] but there are increasing reports of successful bridge to transplant using awake and ambulatory ECMO approaches in patients with chronic respiratory conditions. [8][9][10][11][12][13][14][15][16][17][18][19] We report the first successful bridge to lung transplant with ambulatory ECMO in a previously healthy pediatric patient with acute refractory respiratory failure.…”

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confidence: 99%

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Ambulatory ECMO as a Bridge to Lung Transplant in a Previously Well Pediatric Patient With ARDS

et al. 2014

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Ambulatory ECMO as a Bridge to Lung Transplant in a Previously Well Pediatric Patient With ARDS abstractExtracorporeal membrane oxygenation (ECMO) is increasingly implemented in patients with end-stage pulmonary disease as a bridge to lung transplant. Several centers have instituted an approach that involves physical rehabilitation and ambulation for patients supported with ECMO. Recent reports describe the successful use of ambulatory ECMO in patients with chronic respiratory illnesses being bridged to lung transplant. We describe the first case of a previously healthy pediatric patient with acute respiratory failure successfully supported with ambulatory ECMO as a bridge to lung transplant after an unsuccessful bridge to recovery. Although there are challenges associated with awake and ambulatory ECMO in children, this strategy represents an exciting breakthrough and a potential paradigm shift in ECMO management for pediatric acute respiratory failure. Extracorporeal membrane oxygenation (ECMO) is an important therapeutic modality for patients with refractory respiratory failure. Despite extremely high predicted mortality in patients with refractory respiratory failure, survival for some populations supported with ECMO exceeds 70%. [1][2][3] However, in patients with irreversible pulmonary injury, lung transplant may be necessary. Traditional outcomes for ECMO patients bridged to lung transplant are poor, 4-7 but there are increasing reports of successful bridge to transplant using awake and ambulatory ECMO approaches in patients with chronic respiratory conditions. [8][9][10][11][12][13][14][15][16][17][18][19] We report the first successful bridge to lung transplant with ambulatory ECMO in a previously healthy pediatric patient with acute refractory respiratory failure. CASE DESCRIPTIONA 16-year-old, previously healthy, physically active girl presented to a community hospital with right lower lobe pneumonia and respiratory failure (Fig 1). Her condition deteriorated rapidly, prompting transfer to our quaternary care center for possible ECMO. Upon admission to our institution, the patient' s chest radiograph demonstrated diffuse infiltrates, bilateral pneumothoracies, and pneumomediastinum (Fig 2). She was immediately placed on high-frequency oscillatory ventilation, but because of an oxygen index persistently .40, frequent desaturations, and worsening air leak, venovenous ECMO was initiated via a 27-French double-lumen right internal jugular vein cannula (Avalon Laboratories, Rancho Domingo, CA) ∼30 hours after admission. For the next 4 weeks she needed deep pharmacologic sedation, intermittent neuromuscular blockade, and mechanical ventilation in conjunction with ECMO to maintain gas exchange. During this 4-week period, her air leak resolved, but she continued to have persistent acute respiratory distress syndrome and no improvement. A transbronchial biopsy revealed no infectious etiology, and the pathology results demonstrated organizing and proliferative diffuse alveolar damage and neutrophilic alveolitis...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Ambulatory ECMO as a Bridge to Lung Transplant in a Previously Well Pediatric Patient With ARDS

et al. 2014

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“…[2][3][4] Initial studies of subjects who required extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation demonstrated even lower survival rates. [4][5][6] These survival trends are likely representative of historically late initiation of ECMO for those patients in need of lung transplantation. Ambulation while supported with ECMO, which we hypothesize to be a survival benefit, has not been performed in prior survival analyses.…”

Section: Introductionmentioning

confidence: 99%

Economic Outcomes of Extracorporeal Membrane Oxygenation With and Without Ambulation as a Bridge to Lung Transplantation

et al. 2015

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“…In the past few years, we have successfully used this approach in postoperative PAH after repair of congenital heart disease. The possibility of ECMO weaning may increase the potential success of LT, as reported by several groups (2,5). ECMO can be used in conscious adults and children.…”

Section: Discussionmentioning

confidence: 93%

Successful lung transplant after prolonged Extracorporeal Membrane Oxygenation (ECMO) in a child with pulmonary hypertension: A case report

Beghetti¹,

Tissot²,

Habre³

et al. 2016

Res Cardiovasc Med

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Introduction: The use of extracorporeal membrane oxygenation (ECMO) is considered a risk factor for, or even a potential contraindication to, lung transplantation. However, only a few pediatric cases have been described thus far. Case Presentation: A 9-year-old boy with idiopathic pulmonary arterial hypertension developed cardiac arrest after the insertion of a central catheter. ECMO was used as a bridge to lung transplantation. However, after prolonged resuscitation, he developed medullary ischemia and medullary syndrome. After 6 weeks of ECMO and triple combination therapy for pulmonary hypertension, including continuous intravenous prostacyclin, he was weaned off support, and after 2 weeks, bilateral lung transplantation was performed. At 4 years post-transplant, he has minimal problems. The medullary syndrome has also alleviated. He is now back to school and can walk with aids. Conclusions: Increasing evidence supports the use of ECMO as a bridge to LT, reporting good outcomes. In the modern era of PAH therapy, it is feasible to use prolonged ECMO support as a bridge to lung transplant, with the aim of weaning off this support; however, its use requires more experience and knowledge of long-term outcomes.

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Extracorporeal membrane oxygenation in pediatric lung transplantation

Abstract: Need for perioperative extracorporeal membrane oxygenation support is associated with significant morbidity and mortality among pediatric patients receiving lung transplants. A subset of patients who can be weaned from support preoperatively have greater likelihood of survival.

Cited by 72 publications

References 18 publications

Ambulatory ECMO as a Bridge to Lung Transplant in a Previously Well Pediatric Patient With ARDS

Ambulatory ECMO as a Bridge to Lung Transplant in a Previously Well Pediatric Patient With ARDS

Economic Outcomes of Extracorporeal Membrane Oxygenation With and Without Ambulation as a Bridge to Lung Transplantation

Successful lung transplant after prolonged Extracorporeal Membrane Oxygenation (ECMO) in a child with pulmonary hypertension: A case report

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