Beauty of brevity
Use of Extracorporeal Membrane Oxygenation as a Bridge to Primary Lung Transplant: 3 Consecutive, Successful Cases and a Review of the Literature

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Many transplant centers have considered extracorporeal membrane oxygenation (ECMO) to be a contraindication to lung transplantation, due to historically poor outcomes. However, recent advances in the technical aspects of ECMO have enabled patients to be supported with relative safety for several weeks until a donor lung becomes available. We present 3 young patients with acute (in 1 case, acute on chronic), severe respiratory failure that was refractory to conventional ventilation, who were placed on venovenous ECMO. In each case, a clinical decision was made that the patient’s respiratory failure was irreversible and they were successfully managed with urgent lung transplantation.

Section snippets

Case Reports

Over the last 5 years there have been approximately 45 patients in our transplant center’s catchment area with acute, severe respiratory failure who were treated with ECMO. Our lung transplant physicians were asked by the referring hospitals to consider listing 7 of these patients for lung transplantation. Of these, 3 were not listed due to medical contraindications and 4 were listed for urgent lung transplantation. One of the patients was later de-listed due to recovery of lung function. The

Discussion

The reporting of the use of ECMO as a bridge to primary or re-do lung transplant is limited to a handful of case reports and very small case series spread over some 30 years.

In 1975, the first case of ECMO as a bridge to lung transplant was performed for post-traumatic respiratory failure.3 The patient was successfully weaned from ECMO after the transplant. However, he died 10 days post-transplant from a combination of sepsis, bronchial leak and size mismatch. Interestingly, this was only the

References (22)

  • N. Saunders et al.

    Sequential bilateral lung transplantation for paraquat poisoning

    J Thorac Cardiovasc Surg

    (1985)
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