Extracorporeal Membrane Oxygenation as a Novel Bridging Strategy for Acute Right Heart Failure in Group 1 Pulmonary Arterial Hypertension

Rosenzweig, Erika B.*; Brodie, Daniel; Abrams, Darryl C.; Agerstrand, Cara L.; Bacchetta, Matthew

ASAIO Journal:
doi: 10.1097/MAT.0000000000000021
Case Series
Abstract

Patients with group 1 pulmonary arterial hypertension (PAH) and decompensated right heart failure (RHF) were not previously considered for extracorporeal membrane oxygenation (ECMO) as bridge to transplantation (BTT) or bridge to recovery (BTR) because options were limited by long transplantation wait times and perceived inability to wean ECMO. In a retrospective review, we describe our center’s multidisciplinary mechanical–medical approach to ECMO as a bridging therapy for PAH (2009–2012). Suitability for ECMO was determined using a defined algorithm. Six patients (age, 32 ± 11 years) underwent mechanical–medical bridging. Two transplant-eligible patients underwent successful BTT. The four patients ineligible for transplantation underwent BTR with escalation of targeted medical therapies before weaning off ECMO. Three of four BTR patients survived to ECMO decannulation (duration, 12 ± 7; range, 7–23 days). In this single-institution experience, mechanical–medical BTT and BTR with ECMO and targeted PAH therapies were used as a novel treatment strategy to successfully manage acute RHF in PAH.

Author Information

From the *Division of Pediatric Cardiology, Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, New York; Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York; and Division of Cardiothoracic Surgery, Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, New York.

Submitted for consideration August 2013; accepted for publication in revised form October 2013.

Disclosures: Dr. Brodie reports receiving research support from Maquet Cardiovascular including travel expenses for research meetings, research support for the current study as well as anticipated support for upcoming studies and compensation paid to Columbia University for research consulting. He receives no direct compensation from Maquet. He is a member of the Medical Advisory Board for ALung Technologies. Compensation is paid to Columbia University; he receives no direct compensation from ALung Technologies. Dr. Bacchetta reports receiving research support from Maquet Cardiovascular including travel expenses for research meetings, research support for the current study as well as anticipated support for upcoming studies and compensation paid to Columbia University for research consulting. He receives no direct compensation from Maquet. The remaining authors have no conflicts of interest to report.

Reprint Requests: Erika B. Rosenzweig, Pulmonary Hypertension Center, Columbia University Medical Center, New York Presbyterian, 3959 Broadway, CH-2N, New York, NY 10032. Email: esb14@columbia.edu.

Copyright © 2014 by the American Society for Artificial Internal Organs