title: Successful extracorporeal membrane oxygenation therapy as a bridge to sequential bilateral lung transplantation for a patient after severe paraquat poisoning.
abstract: BACKGROUND
  Paraquat is a widely used herbicide that can cause severe to fatal poisoning in humans. The irreversible and rapid progression of pulmonary fibrosis associated with respiratory failure is the main cause of death in the later stages of poisoning. There are infrequent reports of successful lung transplants for cases of severe paraquat poisoning. We expect that this successful case will provide a reference for other patients in similar circumstances.
  
  
  METHODS
  A 24-year-old female was sent to the hospital approximately 2 hours after ingesting 50 ml of paraquat. She experienced rapidly aggravated pulmonary fibrosis and severe respiratory failure. On the 34th day after ingestion, she underwent intubation and invasive mechanical ventilation. The patient was evaluated for lung transplantation, and veno-venous extracorporeal membrane oxygenation (ECMO) was established as a bridge to lung transplantation on the 44th day. On the 56th day, she successfully underwent a bilateral sequential lung transplantation. Through respiratory and physical rehabilitation and nutrition support, the patient was weaned from mechanical ventilation and extubated on the 66th day. On the 80th day, she was discharged. During the 1-year follow-up, the patient was found to be in good condition, and her pulmonary function improved gradually.
  
  
  CONCLUSIONS
  We suggest that lung transplantation may be an effective treatment in the end stages of paraquat-induced pulmonary fibrosis and consequential respiratory failure. For patients experiencing a rapid progression to a critical condition in whom lung transplantation cannot be performed immediately (e.g., while awaiting a viable donor or toxicant clearance), ECMO should be a viable bridge to lung transplantation.
authors: a Department of Respiratory and Critical Care Medicine , Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine , Beijing , China.
authors: Xiao
authors: X
authors: Tang
authors: a Department of Respiratory and Critical Care Medicine , Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine , Beijing , China.
authors: Bing
authors: B
authors: Sun
authors: a Department of Respiratory and Critical Care Medicine , Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine , Beijing , China.
authors: Hangyong
authors: H
authors: He
authors: b Department of Thoracic Surgery , Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine , Beijing , China.
authors: Hui
authors: H
authors: Li
authors: b Department of Thoracic Surgery , Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine , Beijing , China.
authors: Bin
authors: B
authors: Hu
authors: c Department of Poisoning , The 307 Hospital of the Chinese People's Liberation Army , Beijing , China.
authors: Zewu
authors: Z
authors: Qiu
authors: a Department of Respiratory and Critical Care Medicine , Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine , Beijing , China.
authors: Jie
authors: J
authors: Li
authors: a Department of Respiratory and Critical Care Medicine , Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine , Beijing , China.
authors: Chunyan
authors: C
authors: Zhang
authors: b Department of Thoracic Surgery , Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine , Beijing , China.
authors: Shengcai
authors: S
authors: Hou
authors: a Department of Respiratory and Critical Care Medicine , Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine , Beijing , China.
authors: Zhaohui
authors: Z
authors: Tong
authors: a Department of Respiratory and Critical Care Medicine , Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine , Beijing , China.
authors: Huaping
authors: H
authors: Dai
mesh_terms: D055371:Acute Lung Injury; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006540:Herbicides / Q000506:poisoning*; D006801:Humans; D016040:Lung Transplantation; D010269:Paraquat / Q000506:poisoning*; D011041:Poisoning / Q000175:diagnosis / Q000628:therapy; D011654:Pulmonary Edema / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy*; D011658:Pulmonary Fibrosis / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy*; D012720:Severity of Illness Index; D013406:Suicide, Attempted; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D006540:Herbicides; D010269:Paraquat
keywords: Paraquat poisoning; chronic hepatitis B; depression; extracorporeal membrane oxygenation therapy; lung transplantation