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Lung Transplantation After 125 Days on ECMO for Severe Refractory Hypoxemia With No Prior Lung Disease

Salam, Shameen*; Kotloff, Robert; Garcha, Puneet; Krishnan, Sudhir; Joshi, Dhruv; Grady, Patrick§; Duggal, Abhijit

doi: 10.1097/MAT.0000000000000450
Case Reports

Venovenous extracorporeal membrane oxygenation (ECMO) has become a viable and increasingly utilized option for the treatment of refractory hypoxemia in severe acute respiratory distress syndrome (ARDS). However, options are limited for ARDS patients who fail to wean from ECMO. The high rates of infection, presence of extrapulmonary end organ damage, intensive care unit-acquired weakness, and high short-term mortality associated with ARDS are all significant hurdles that make lung transplantation a difficult prospect to consider. However, ECMO support has been used as a bridge to transplant in patients with other underlying chronic lung diseases. Our case illustrates the successful use of lung transplantation for a patient with no previous lung disease who developed refractory ARDS requiring protracted ECMO support. The use of ambulatory ECMO with early institution of physical therapy is an essential component in preparing such patients for successful transplantation.

From the *Department of Chest diseases, St Vincent’s Medical Institute and Research Centre, Erie, Pennsylvania; Department of Pulmonary, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio; Department of Pulmonary and Critical Care, Baylor University Medical Center, Baylor, Texas; §Department of Perfusion, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; and Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.

Submitted for consideration November 2015; accepted for publication in revised form September 2016.

Disclosure: The authors have no conflicts of interest to report.

Correspondence: Shameen Salam, Department of Chest Diseases, St Vincent’s Medical Institute and Research Centre, Erie, Pennsylvania 16502. Email: shameen.salam.ccf@gmail.com.

Copyright © 2017 by the American Society for Artificial Internal Organs