Bridge to lung transplantation by venovenous extracorporeal membrane oxygenation: a lesson learned on the first four cases.
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.
Thoracic Surgery and Lung Transplantation Unit, Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milano, Italy.
M
M
Nosotti
L
L
Rosso
A
A
Palleschi
A
A
Lissoni
S
S
Crotti
C
C
Marenghi
C
C
Colombo
D
D
Costantini
L
L
Santambrogio
D000328:Adult; D003550:Cystic Fibrosis / Q000628:therapy; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011658:Pulmonary Fibrosis / Q000628:therapy; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult