Lung Transplantation as a Therapeutic Option in Acute Respiratory Distress Syndrome

Chang, Youjin; Lee, Sang‐Oh; Shim, Tae Sun; Choi, Seong Hun; Kim, Hyung Ryul; Kim, Yong Hee; Kim, Dong Kwan; Do, Kyung-Hyun; Choi, In‐Cheol; Hong, Sang‐Bum; Park, Seung-Il

doi:10.1097/tp.0000000000002004

Cited by 37 publications

(38 citation statements)

References 28 publications

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“…20 Extensive irreversible fibrotic lung changes in severe ARDS were the biggest reason for the prolonged ECMO run in our case, ECMO was instituted after 7 days of invasive ventilation, and probably fibrotic phase of ARDS had set in by then. Similar experiences were quoted by Ali et al 17 who noted irreversible interstitial fibrosis and connective tissue changes in their patient.…”

Section: Discussionsupporting

confidence: 85%

“…18 Ali et al had to change theirs seven times. 17 We in our case did not encounter heparin-induced thrombocytopenia and thrombosis (HITT) or heparin resistance during the 3-month period of ECMO run. Raza et al reported HITT in their case requiring switching of heparin over to argatroban.…”

Section: Discussionmentioning

confidence: 60%

“…Ali et al and Raza et al also described similar difficulties in their study. 17,20 But the authors Umei et al and Kim et al were able to bridge the ECMO to lung transplantation successfully in their patients. 18,19 Adequate nutrition, mobilization, and regular on bed physiotherapy are extremely important to maintain musculoskeletal function.…”

Section: Discussionmentioning

confidence: 99%

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A 92 Days Run of Venovenous Extracorporeal Membrane Oxygenation

Sahu

Bipin

Pahuja

et al. 2020

Journal of Cardiac Critical Care TSS

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Background Venovenous extracorporeal membrane oxygenation (VV-ECMO) is an established life-saving procedure for severe acute respiratory failure due to various causes. In general, the duration of ECMO ranges from 1 to 2 weeks, with withdrawal recommended if no improvement is noted. We report a case of respiratory failure due to acute respiratory distress syndrome (ARDS) following influenza A infection, supported with a long ECMO run and the lessons learned from this experience. Case Report A 40-year-old female weighing 120 kg with pneumonia following H1N1 influenza was transferred to our hospital on mechanical ventilation for worsening respiratory distress. On admission, she presented with bilateral diffuse infiltrates on chest X-ray and severe hypoxemia with a partial pressure of oxygen in arterial blood/fraction of inspired oxygen concentration ratio (PaO2/FiO2) of 85 at FiO2 of 0.8 on endotracheal intubation and mechanical ventilation. Acinetobacter Baumannii was isolated from respiratory secretions; antibiotics were revised as per sensitivity. Her respiratory status further deteriorated over next 96 hours in spite of maximally optimized mechanical ventilation. VV-ECMO was established on 4th day of mechanical ventilation in our hospital. Thereafter, she underwent a prolonged ECMO run with respiratory improvement starting to show some promise only by 86th day of ECMO. Weaning process was initiated gradually. However, on 88th day of ECMO the patient had an episode of seizure followed by low Glasgow Coma Scale (GCS) score (3T/15). The patient did not recover from the cerebral insult and based on clinical neurological examination including apnea test, brain death was determined within next 48 hours and the ECMO was called off. Conclusions Prolonged ECMO therapy poses many challenges and might be considered if the primary cause of respiratory failure necessitating ECMO is expected to resolve or a feasibility of lung transplantation is contemplated. Good team dynamics and appropriate counselling to the family are of utmost importance managing the patients on prolonged ECMO.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 60%

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A 92 Days Run of Venovenous Extracorporeal Membrane Oxygenation

Sahu

Bipin

Pahuja

et al. 2020

Journal of Cardiac Critical Care TSS

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“…[ 10 ] ECMO is believed to contribute to lung function recovery in severely infected patients and it serves as a bridge treatment before LT. LT has been shown to be beneficial for patients with pneumonia-induced ARDS and post-ARDS pulmonary fibrosis receiving long-term MV. [ 11 ] The fact that young individuals receiving ECMO for a short time could be considered as candidates for LT after deliberate pre-transplant consultation is generally accepted. [ 12 ] However, our transplanted patients had higher SOFA scores than those reported in critical COVID-19 populations, indicating a high risk of mortality.…”

Section: Discussionmentioning

confidence: 99%

Lung transplantation as therapeutic option in acute respiratory distress syndrome for coronavirus disease 2019-related pulmonary fibrosis

Chen

Qiao

Liu

et al. 2020

Chinese Medical Journal

162

174

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Background Critical patients with the coronavirus disease 2019 (COVID-19), even those whose nucleic acid test results had turned negative and those receiving maximal medical support, have been noted to progress to irreversible fatal respiratory failure. Lung transplantation (LT) as the sole therapy for end-stage pulmonary fibrosis related to acute respiratory distress syndrome has been considered as the ultimate rescue therapy for these patients. Methods From February 10 to March 10, 2020, three male patients were urgently assessed and listed for transplantation. After conducting a full ethical review and after obtaining assent from the family of the patients, we performed three LT procedures for COVID-19 patients with illness durations of more than one month and extremely high sequential organ failure assessment scores. Results Two of the three recipients survived post-LT and started participating in a rehabilitation program. Pearls of the LT team collaboration and perioperative logistics were summarized and continually improved. The pathological results of the explanted lungs were concordant with the critical clinical manifestation, and provided insight towards better understanding of the disease. Government health affair systems, virology detection tools, and modern communication technology all play key roles towards the survival of the patients and their rehabilitation. Conclusions LT can be performed in end-stage patients with respiratory failure due to COVID-19-related pulmonary fibrosis. If confirmed positive-turned-negative virology status without organ dysfunction that could contraindicate LT, LT provided the final option for these patients to avoid certain death, with proper protection of transplant surgeons and medical staffs. By ensuring instant seamless care for both patients and medical teams, the goal of reducing the mortality rate and salvaging the lives of patients with COVID-19 can be attained.

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“…In addition, it can be considered as a salvage therapy for carefully selected patients who have severe treatment-refractory ARDS. 5 However, wide uncertainty exists as to whether lung transplantation could have a place in the treatment of severe COVID-19 and, if so, what the optimal timing for such a treatment should be. Herein, we report the first case of lung transplantation for a patient with a persistently positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) real-time RT-PCR test result.…”

mentioning

confidence: 99%

Lung transplantation for COVID-19-associated acute respiratory distress syndrome in a PCR-positive patient

Lang

Jaksch

Hoda

et al. 2020

The Lancet Respiratory Medicine

112

126

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Lung Transplantation as a Therapeutic Option in Acute Respiratory Distress Syndrome

Abstract: LTPL may be considered as a therapeutic option in a select group of patients with severe ARDS. However, the irreversibility of the patient's lung status should be considered.

Cited by 37 publications

References 28 publications

A 92 Days Run of Venovenous Extracorporeal Membrane Oxygenation

A 92 Days Run of Venovenous Extracorporeal Membrane Oxygenation

Lung transplantation as therapeutic option in acute respiratory distress syndrome for coronavirus disease 2019-related pulmonary fibrosis

Lung transplantation for COVID-19-associated acute respiratory distress syndrome in a PCR-positive patient

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