Extracorporeal Membrane Oxygenation as a Bridge to Emergency Heart-Lung Transplantation in a Patient With Idiopathic Pulmonary Arterial Hypertension

“Treat-to-target” in pulmonary arterial hypertension and the use of extracorporeal membrane oxygenation as a bridge to transplantation: Table 1.

“…Recently, some relevant articles on EPE epidemiology have been published. Our analysis of the largest, single-centre treated group of patients with EPE showed that a causative diagnosis was not established in only 14.1% of these patients [18]. A similar result (15.6% idiopathic EPEs) was reported by MARTINEZ-GARCIA et al [19].…”

“…In the past, although increasingly used for adults with ventilationrefractory acute severe respiratory failure, ECMO has, in general, been considered to be a contraindication to lung transplantation [13,14]. However, there are an increasing number of reports in the literature on the use of this method as a bridge to lung transplantation in patients with a number of underlying conditions, including acute severe respiratory failure [13], acute respiratory distress syndrome [15], cystic fibrosis [16] and pulmonary hypertension [17][18][19][20]. A recent report of outcomes in 16 patients with end-stage pulmonary disease found that, in those who survived to transplantation, 1-yr post-transplant survival was 92% [21].…”

Renal Replacement Therapy in Patients with Severe Precapillary Pulmonary Hypertension with Acute Right Heart Failure

“…This raises the question of novel therapeutic approaches, such as early listing for lung transplantation (for eligible patients) and/or cardiac assist devices when AKI develops in the setting of heart failure [20,21,22]. RRT while on interventional lung assist membrane ventilator treatment in ARDS has been evaluated and proved favorable in ICU outcomes as a bridge in transplanted patients [23].…”

Veno-venous extracorporeal membrane oxygenation bridging to pharmacotherapy in pulmonary arterial hypertensive crisis

“…VA-ECMO was initiated and successful bridge to combined heart-lung transplantation was achieved. 8 Given the size of the PFO in our patient, we elected to pursue VV-ECMO, postulating that a significant fraction of the oxygenated blood would be shunted across the interatrial septum, improving left ventricular filling and reducing the risks of pulmonary hemorrhage and pulmonary edema from rapidly increased pulmonary blood flow. The immediate increase in blood pressure and systemic oxygenation in the absence of hemoptysis after VV-ECMO initiation supports this hypothesis.…”