Thoracic transplantation
Lung
Bridge to Lung Transplantation by Venovenous Extracorporeal Membrane Oxygenation: A Lesson Learned on the First Four Cases

https://doi.org/10.1016/j.transproceed.2010.03.119Get rights and content

Abstract

Extracorporeal membrane oxygenation (ECMO) is the only therapeutic option for patients with ventilation-refractory hypercapnia while awaiting lung transplantation. Moreover, there is increasing success using ECMO for definitive respiratory failure in formerly healthy patients. This report describes the use of membrane oxygenation as a bridge to lung transplantation in 2 patients on the waiting list and in 2 previously healthy patients.

Our experience showed that coagulation management, critical illness myopathy, and psychological disorders were the most critical problems. One patient died at 2 days after transplantation, 1 at 3 months, and 2 returned to their pretransplantation activities.

We concluded that ECMO is an adequate bridge to lung transplantation but, especially in formerly healthy patients, an awake procedure is advisable for a successful outcome.

Section snippets

Patients and Methods

In the last 2 years, 4 patients who were treated with ECMO in our intensive care unit were listed for urgent lung transplantation. Two were previously healthy persons; the other 2 were awaiting lung transplantation. Table 1 a synthesizes the clinical data.

Discussion

In the new millennium, ECMO has been successfully used as a bridge to lung transplantation. We have previously reported a short review of the 25 published clinical cases,3 adding our new 3 cases and the experience from Gothenburg (Sweden)4; 29 procedures are now available for analysis. Among that patient group, 8 individuals were in apparently good condition before a respiratory crisis produced a dramatic, definitive impairment of pulmonary function.

Our experience highlights at least 3 points

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