Pulmonary hypertension (PH) is a challenging disease process to manage. Respiratory and hemodynamic changes that accompany general anesthesia lead to a significant risk of cardiovascular collapse. Certain cases of decompensated PH require extracorporeal membrane oxygenation (ECMO) support as either a bridge to lung transplantation or bridge to recovery. Performing ECMO cannulation without intubation or general anesthesia in these patients may be safer given the severity of their underlying disease process. We present three cases of upper body ECMO cannulation performed on patients with pulmonary hypertension while awake and without mechanical ventilation.
From the *Department of Cardiothoracic Surgery; †Department of Anesthesiology, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY; ‡Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA; and §Department of Pediatric Cardiology, Columbia University Medical Center, New York, NY.
Submitted for consideration February 2014; accepted for publication in revised form June 2014.
Disclosures: Dr. Bacchetta has consulted for Maquet Inc., a non-remuneration agreement. Dr. Berman-Rosenzweig consulted for Actelion, Gilead, Ikaria, and United Therapeutics. She has ongoing research grants with Actelion, Bayer, Gilead, United Therapeutics, Glaxo-Smith-Kline, and Eli Lilly.
Correspondence: Mauer Biscotti, MD, Columbia University Medical Center, New York, NY 10032. Email: firstname.lastname@example.org