Lung transplantation following 107 days of extracorporeal membrane oxygenation

Abstract

Severe adult respiratory distress syndrome (ARDS) is associated with failure to maintain adequate gas exchange. There is increasing success using extracorporeal membrane oxygenation (ECMO) for respiratory failure; the longest reported surviving patient has been supported by ECMO for 57 days. At best about 50% wean from ECMO and should weaning fail their course is fatal. ECMO is generally considered to be a contraindication for successful lung transplantation. This report describes a patient maintained on ECMO for 107 days who underwent bilateral lung transplantation and weaned from organ-perfusion support. He survived for 351 days post-transplantation and died from Pseudomonas aeruginosa pneumonia. ECMO can be used for prolonged intervals to support patients with severe ARDS without complications that preclude lung transplantation. As ECMO use becomes more frequent, it becomes critical to determine criteria that would optimise patient selection for transplantation from ECMO.

Long-Term Venovenous Extracorporeal Membrane Oxygenation Support for Acute Respiratory Distress Syndrome

“…In 2010, our group reported a 107-day bridge to transplant with venovenous ECMO in a patient with ARDS. The patient survived for 351 days after lung transplantation before dying of pneumonia [7]. Most recently, we have successfully bridged a 22-year-old female patient with postpartum ARDS to lung transplantation after 155 days of ECMO support [8].…”

Support time-dependent outcome analysis for veno-venous extracorporeal membrane oxygenation

“…The importance of pulmonary support by veno-venous (VV) ECMO is also underlined by the remarkable survival rates of almost 80% in patients suffering from an H1N1 infection and severe pulmonary failure [8]. Another rather new application area of ECMO is as bridge to lung transplantation where support intervals of 11-107 consecutive days have been reported [9][10][11]. However, the experience with longterm extracorporeal pulmonary support remains limited.…”

"Treat-to-target" in pulmonary arterial hypertension and the use of extracorporeal membrane oxygenation as a bridge to transplantation

“…Interestingly, when valproic acid and clozapine are used together, clozapine might be a true cause of pleural effusion as demonstrated by DALY et al [14]. Clozapine-induced pleuritis was reported in one patient who was concomitantly treated with olanzapine [15]. These examples show the crucial role of thorough clinical evaluation, including drug withdrawal and re-challenge in making a causative diagnosis of druginduced pleural effusion.…”

“…In the past, although increasingly used for adults with ventilationrefractory acute severe respiratory failure, ECMO has, in general, been considered to be a contraindication to lung transplantation [13,14]. However, there are an increasing number of reports in the literature on the use of this method as a bridge to lung transplantation in patients with a number of underlying conditions, including acute severe respiratory failure [13], acute respiratory distress syndrome [15], cystic fibrosis [16] and pulmonary hypertension [17][18][19][20]. A recent report of outcomes in 16 patients with end-stage pulmonary disease found that, in those who survived to transplantation, 1-yr post-transplant survival was 92% [21].…”

“…The duration of ECMO support in this study ranged from 1 to 59 days (mean 17 days). ECMO has been reported to have been used for up to 107 days as a bridge to transplantation [15] and several weeks' use is not uncommon [22]. In general, ECMO is used in conjunction with prolonged sedation and mechanical ventilation, increasing the risks associated with the technique.…”