Lung Transplants for COVID-19—The Option of Last Resort

Walter, Kristin

doi:10.1001/jama.2021.9363

Cited by 9 publications

(8 citation statements)

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“…It is not clear which patients may have reasonable chances of recovery and whether very prolonged severe alterations in pulmonary function may reverse. In exceptional cases, persistent acute respiratory distress syndrome (ARDS) leads to pulmonary transplantation as the last resort in COVID‐19 patients supported by vvECMO 3,4 . However, pursuing medical management is futile, and at which stage aggressive interventions such as lung transplantation should be undertaken is unknown.…”

Section: Introductionmentioning

confidence: 99%

Reversibility of total airway closure and alveolar consolidation in a COVID‐19 patient: A case study

Voicu

Brudon

Modestin

et al. 2021

Nursing in Critical Care

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Coronavirus disease 2019 (COVID-19) may be complicated by life-threatening pneumonia requiring tracheal intubation, mechanical ventilation and veno-venous extracorporeal membrane oxygenation (vvECMO). It is not yet clear to what extent and after which delay the most severe cases of COVID-19 pneumonia are reversible. Here, we present a 39-year-old patient who developed a severe COVID-19-attributed acute respiratory distress syndrome (ARDS) resulting in complete alveolar consolidation and airway closure for several weeks. His remarkable ventilatory pattern was established using ventilator airway pressure curve analysis and computed tomography imaging. The patient was managed with supportive care, mechanical ventilation and vvECMO. He received dexamethasone and tocilizumab as immunomodulatory drugs. Despite multiple complications, he recovered and was weaned from vvECMO, ventilator and oxygen on days 75, 95 and 99 post-intubation, respectively. He was discharged from hospital on day 113. This case study strongly supports the remarkable potential for reversibility of ARDS in COVID-19 patients and discusses the implications for critical care nursing regarding mechanical ventilation and ECMO device management in patients who may become entirely dependent on vvECMO for oxygenation and carbon dioxide elimination.

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Section: Introductionmentioning

confidence: 99%

Reversibility of total airway closure and alveolar consolidation in a COVID‐19 patient: A case study

Voicu

Brudon

Modestin

et al. 2021

Nursing in Critical Care

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“…High cost, presence of a robust transplant programme and availability of donor lungs are other challenges faced by potential lung transplant candidates. 11,17,18 Our case is unique in several aspects. Ltx can be carried out successfully among patients with COVID-19-related pulmonary fibrosis even in the developing world.…”

Section: Discussionmentioning

confidence: 84%

“…High cost, presence of a robust transplant programme and availability of donor lungs are other challenges faced by potential lung transplant candidates. 11 , 17 , 18 …”

Section: Discussionmentioning

confidence: 99%

Lung transplantation for post‐COVID‐19 pulmonary fibrosis

Gogia

Attawar

Singh

et al. 2021

Respirology Case Reports

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COVID-19 has affected over a billion people around the world, with over 2 million losing their lives (Worldometer). About 10% of patients infected with COVID-19 develop a serious illness, including respiratory failure, that require advanced life-supporting measures. Mortality among this subgroup exceeds 60%. We present a case of an otherwise healthy 34-year-old male who developed end-stage pulmonary fibrosis following COVID-19 infection. He achieved haemodynamic stability with mechanical ventilation and extracorporeal membrane oxygenation (ECMO) but did not show any sign of weaning off ECMO; however, he successfully underwent bilateral lung transplantation.

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“…None of our patients achieved the conditions requested for lung transplantation by the thoracic surgeons of our university hospital group. Lung transplant in COVID-19 patients is a controversial issue, despite recently reported excellent results as option of last resort [19]. Whether some selected COVID-19 patients with end-stage lung disease might be candidates for lung transplant from compromised donors, remains also to be investigated.…”

Section: Discussionmentioning

confidence: 99%

Dismal Survival in COVID-19 Patients Requiring ECMO as Rescue Therapy after Corticosteroid Failure

Voicu

Goury

Lacoste-Palasset

et al. 2021

JPM

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(1) Background: COVID-19 may lead to refractory hypoxemia requiring venovenous extracorporeal membrane oxygenation (ECMO). Survival rate if ECMO is implemented as rescue therapy after corticosteroid failure is unknown. We aimed to investigate if ECMO implemented after failure of the full-recommended 10-day corticosteroid course can improve outcome. (2) Methods: We conducted a three-center cohort study including consecutive dexamethasone-treated COVID-19 patients requiring ECMO between 03/2020 and 05/2021. We compared survival at hospital discharge between patients implemented after (ECMO-after group) and before the end of the 10-day dexamethasone course (ECMO-before group). (3) Results: Forty patients (28M/12F; age, 57 years (51–62) (median (25th–75th percentiles)) were included, 28 (70%) in the ECMO-before and 12 (30%) in the ECMO-after group. In the ECMO-before group, 9/28 patients (32%) received the 6 mg/day dexamethasone regimen versus 12/12 (100%) in the ECMO-after group (p < 0.0001). The rest of the patients received an alternative dexamethasone regimen consisting of 20 mg/day during 5 days followed by 10 mg/day during 5 days. Patients in the ECMO-before group tended to be younger (57 years (51–59) versus 62 years (57–67), p = 0.053). In the ECMO-after group, no patient (0%) survived while 12 patients (43%) survived in the ECMO-before group (p = 0.007). (4) Conclusions: Survival is poor in COVID-19 patients requiring ECMO implemented after the full-recommended 10-day dexamethasone course. Since these patients may have developed a particularly severe presentation, new therapeutic strategies are urgently required.

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Lung Transplants for COVID-19—The Option of Last Resort

Abstract: This Medical News article is an interview with Ankit Bharat, MD, a surgeon at Chicago’s Northwestern Memorial Hospital who performed the first bilateral lung transplant for COVID-19 in the US.

Cited by 9 publications

References 0 publications

Reversibility of total airway closure and alveolar consolidation in a COVID‐19 patient: A case study

Reversibility of total airway closure and alveolar consolidation in a COVID‐19 patient: A case study

Lung transplantation for post‐COVID‐19 pulmonary fibrosis

Dismal Survival in COVID-19 Patients Requiring ECMO as Rescue Therapy after Corticosteroid Failure

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