Extracorporeal membrane oxygenation in the pre and post lung transplant period

Sharma, Nirmal; Hartwig, M.; Hayes, Don

doi:10.21037/atm.2017.02.09

Cited by 38 publications

(36 citation statements)

References 92 publications

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“…In this latter category, the use of extracorporeal membrane oxygenation (ECMO) as a bridge to transplantation or support to lung function in case of severe lung injury is increasingly popular. (10) However, data regarding ceftolozane-tazobactam pharmacokinetics in critically ill patients during ECMO support are lacking.…”

Section: Tablementioning

confidence: 99%

Ceftolozane-tazobactam pharmacokinetics during extracorporeal membrane oxygenation in a lung transplant recipient

Arena¹,

Marchetti

Angelis³

et al. 2018

Preprint

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22Ceftolozane-tazobactam pharmacokinetics during extracorporeal membrane oxygenation (ECMO) 23 has not been previously studied. In this work we report on the ceftolozane and tazobactam 24 plasmatic levels in a lung transplant recipient during ECMO, treated with ceftolozane-tazobactam 25 (2g/1g, intravenously every 8 h, 1 h infusion) for a Pseudomonas aeruginosa pulmonary infection. 26Ceftolozane Cmax and Cmin, monitored during 96 hrs, remained above 60 and 20 µg/mL, 27 respectively, with optimal drug exposure (100% %T MIC ). Tazobactam levels were above 1.9 µg/mL. 28 29 30patient had a normal renal function with creatinine clearance, estimated using the Cockcroft-Gault 83 formula, above 90 mg/min (range 90-150 mg/min) ( Figure 1). 84Ceftolozane and tazobactam plasma concentrations were monitored for 96 h following the first 85 administration. Plasma samples were obtained ½ h after the end of each ceftolozane-tazobactam 86 infusion and immediately before the beginning of the following dose (Cmax and Cmin 87 respectively). The samples were centrifuged at 1,600 g for 10 min to yield at least 1 ml of plasma. 88 Plasma samples were stored at −80°C until the assay. Ceftolozane and tazobactam concentrations 89 were quantified using a validated HPLC method at the Chemotherapy Laboratory of the Department 90 of Health Sciences (University of Florence, Italy). (11) 91In the following days the patient clinical conditions improved and, on day 3 after the lung 92 transplant, the vaECMO was switched again to vvECMO. 93In the 96 h of drug monitoring, the ceftolozane levels remained constantly above the isolate MIC. In 94 the first 48 h, ceftolozane Cmax were persistently above 100 µg/mL. Later, from 48 to 96 h, there 95 was a decline in Cmax and Cmin, which, however, remained above 60 and 20 µg/mL, respectively 96 ( Figure 1). Tazobactam concentration were above 1.9 µg/mL for all the monitored period. 97ECMO was halted on day 8 after lung transplantation. The patient's conditions eventually improved 98 and, on day 15 after lung transplantation, the antimicrobial therapy was discontinued. No adverse 99 events were attributed to the ceftolozane-tazobactam administration. Four consecutive tracheal 100 aspirate cultural exams, performed in the last day of treatment and 3, 4, and 7 days after the 101 antibiotics discontinuation, did not grow P. aeruginosa or any other pathogen. 102Concluding, we documenting the success of ceftolozane-tazobactam treatment for a case of 103 carbapenem-resistant P. aeruginosa LRTI in a lung transplant recipient subjected to ECMO 104 support. TDM revealed that optimal drug exposure was achieved, with a ceftolozane concentration 105 at 100% %T MIC . Of note, in this case, optimal Cmax and Cmin were obtained using a 3 g 106 cefotolozane-tazobactam dose every 8 h, using a standard 1 h infusion time. During the TDM 107 period we assisted to a decrease of ceftolozane/tazobactam Cmin and Cmax that could be attributed 108 6 to the increase in the patient's creatinine clearance values. In fact, it was previo...

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Section: Tablementioning

confidence: 99%

Ceftolozane-tazobactam pharmacokinetics during extracorporeal membrane oxygenation in a lung transplant recipient

Arena¹,

Marchetti

Angelis³

et al. 2018

Preprint

View full text Add to dashboard Cite

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“… 6 This is while Sharma et al have more positive concepts of using ECMO in lung transplantation. 7 In terms of morbidity and mortality, Lang et al presented their experience with ECMO on nine patients among them one developed the only ECMO-related problem in their report, lymphatic fistula at the groin, which needed surgical revision. They also reported one case of perioperative death.…”

Section: Discussionmentioning

confidence: 99%

ECMO-assisted resection of huge thoracic mass

Jahangirifard

Ahmadi

Kakhaki

et al. 2018

J Cardiovasc Thorac Res

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Some advanced thoracic malignancy cannot be resected safely by using of conventional ventilation, so some sort of cardiopulmonary support is needed for hemodynamic and ventilation management of the patient. Using extracorporeal membrane oxygenation (ECMO) in comparing with cardiopulmonary bypass has some advantages. Three patients with huge thoracic tumors with different ages experienced major surgery in our center by using ECMO in order to face major complications mainly due to the size of mass to achieve better hemostatic stabilities, lower bleeding, and injuries to main airways and secure oxygenation. This is the first case series in Iran, as our best knowledge that explains cases of huge chest mass which were operated perfectly by using ECMO and short ICU stay and interestingly no major complications.

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“…Following early successes in improving acute respiratory distress syndrome outcomes, ECMO has found increasing popularity in advanced life support for a variety of indications. 59 Its role in LTx bridging is not without some controversy, with early studies associating ECMO with poorer outcomes. 60 Technological advances and increasing clinical experience have, however, improved to the extent that post-LTx outcomes in ECMO patient may approach non-ECMO patients, particularly in high-volume centers.…”

Section: Bridging To Transplant In Copdmentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease and Lung Transplantation

Greer

Welte

2020

Semin Respir Crit Care Med

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Lung transplantation (LTx) has been a viable option for patients with end-stage chronic obstructive pulmonary disease (COPD), with more than 20,000 procedures performed worldwide. Survival after LTx lags behind most other forms of solid-organ transplantation, with median survival for COPD recipients being a sobering 6.0 years. Given the limited supply of suitable donor organs, not all patients with end-stage COPD are candidates for LTx. We discuss appropriate criteria for accepting patients for LTx, as well as contraindications and exclusionary criteria. In the first year post-LTx, infection and graft failure are the leading causes of death. Beyond this chronic graft rejection—currently referred to as chronic lung allograft dysfunction—represents the leading cause of death at all time points, with infection and over time malignancy also limiting survival. Referral of COPD patients to a lung transplant center should be considered in the presence of progressing disease despite maximal medical therapy. As a rule of thumb, a forced expiratory volume in 1 second < 25% predicted in the absence of exacerbation, hypoxia (PaO2 < 60 mm Hg/8 kPa), and/or hypercapnia (PaCO2 > 50 mm Hg/6.6 kPa) and satisfactory general clinical condition should be considered the basic prerequisites for timely referral. We also discuss salient issues post-LTx and factors that impact posttransplant survival and morbidity such as infections, malignancy, renal insufficiency, and complications associated with long-term immunosuppression.

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Extracorporeal membrane oxygenation in the pre and post lung transplant period

Cited by 38 publications

References 92 publications

Ceftolozane-tazobactam pharmacokinetics during extracorporeal membrane oxygenation in a lung transplant recipient

Ceftolozane-tazobactam pharmacokinetics during extracorporeal membrane oxygenation in a lung transplant recipient

ECMO-assisted resection of huge thoracic mass

Chronic Obstructive Pulmonary Disease and Lung Transplantation

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