Paracorporeal lung assist devices as a bridge to recovery or lung transplantation in neonates and young children

Abstract

Pediatric patients bridged from ECMO to lung transplantation have poor results. An alternative method for longer term respiratory support was necessary as a bridge for these patients. The use of a paracorporeal lung assist device successfully supported 4 patients to recovery, lung transplantation, or past the average wait time for pediatric donor lungs (27 days). This therapy has the potential to bridge children with decompensated respiratory failure to lung transplantation.

Cannulation techniques for extracorporeal life support

“…The arterial return is directed into descending aorta via arterial cannula (15)(16)(17)(18)(19)(20)(21)(22)(23). The size of the cannula depends on calibre of the vessels and flows required to achieve adequate circulatory support.…”

“…It involves diversion the blood from pulmonary artery to gas exchange mebrane with low resistance (Novalung, Maquet Quadrox-iD) and returning the blood to the left atrium (23). The most common indication for this type of respiratory support is bridge to lung transplantation in patients with pulmonary hypertension.…”

Lung Transplantation in Cystic Fibrosis: Trends and Controversies

“…Using PLAD, children with ventilatory failure have been able to await suitable lung donors for more than 2 months. 31 PLAD may be simpler than ECMO to implement, but while PLAD can be effective at carbon dioxide removal, they have less utility in improving oxygenation. 32 Both ECMO and PLAD present challenges in terms of vascular access and infection risk.…”

Diffuse Lung Disease

“…Death usually ensues within a few days or weeks, unless the lung involvement is patchy rather than diffuse (Chow et al 2013), or extracorporeal membrane oxygenation (ECMO) or paracorporeal lung assist devices are available as a bridge to lung transplantation (Sen et al 2004;Michalsky et al 2005;Hoganson et al 2014). Approximately 80 % of cases of ACD/MPV are associated with extrapulmonary malformations, including hypoplastic left heart syndrome, aortic coarctation, alimentary tract atresia, annular pancreas, omphalocele, midgut malrotation, and urinary tract malformation.…”