title: Long-term membrane oxygenator use to support an infant with acute respiratory distress syndrome on biventricular assist device.
abstract: Ventricular assist devices (VADs) are used in children with severe heart failure as a bridge to heart transplantation or recovery. Severe pulmonary dysfunction may preclude their use, leaving extracorporeal membrane oxygenation (ECMO) as the most frequently used option for combined cardiac and respiratory failure. There are few case reports describing the use of an oxygenator in combination with VAD support, but none that describes long-term utilization. We report the successful use of a low-resistance oxygenator placed into the right-sided VAD (RVAD) circuit of an infant with life-threatening respiratory failure. The oxygenator enabled immediate reversal of hypoxaemia and hypercarbia and recovery of the RVAD function. The oxygenator remained within the VAD circuit for 15 days, facilitating complete lung recovery. An oxygenator used in conjunction with a VAD may be a life-saving therapy, allowing adequate oxygenation and ventilation in severe respiratory and cardiac failure. Extended use may facilitate the prevention of ventilator-associated lung injury and organ dysfunction. This therapy may be an attractive intermediate step in the transition from, or alternative to ECMO, in patients requiring VAD placement with associated acute lung injury.
authors.affiliation: Division of Pediatric Critical Care, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
authors.forename: Hayden J
authors.initials: HJ
authors.lastname: Zaccagni
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Timpa
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: O'Meara
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Alten
mesh_terms: D055371:Acute Lung Injury / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015199:Extracorporeal Membrane Oxygenation; D017809:Fatal Outcome; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D011474:Prosthesis Design; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute lung injury; Extracorporeal membrane oxygenation; Oxygenator; Ventricular assist devices