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

Jackson, Andrew; Cropper, Jonathan R.; Pye, R.; Junius, Frank; Malouf, M.A.; Glanville, Allan R.

doi:10.1016/j.healun.2007.12.006

Cited by 102 publications

(76 citation statements)

References 21 publications

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“…[8][9][10][11][12][13][14][15][16][17][18][19] Chronic respiratory insufficiency leads to greater tolerance for dyspnea, as evidenced by the patients supported with ambulatory ECMO who have been managed with minimal respiratory support or even extubated. 8,[15][16][17]19 The impact of weaning both sedation and ventilatory support in children without chronic respiratory disease must be addressed when ambulatory ECMO is considered for previously healthy children.…”

Section: E584mentioning

confidence: 99%

“…Traditional outcomes for ECMO patients bridged to lung transplant are poor, [4][5][6][7] but there are increasing reports of successful bridge to transplant using awake and ambulatory ECMO approaches in patients with chronic respiratory conditions. [8][9][10][11][12][13][14][15][16][17][18][19] We report the first successful bridge to lung transplant with ambulatory ECMO in a previously healthy pediatric patient with acute refractory respiratory failure.…”

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confidence: 93%

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Ambulatory ECMO as a Bridge to Lung Transplant in a Previously Well Pediatric Patient With ARDS

et al. 2014

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Ambulatory ECMO as a Bridge to Lung Transplant in a Previously Well Pediatric Patient With ARDS abstractExtracorporeal membrane oxygenation (ECMO) is increasingly implemented in patients with end-stage pulmonary disease as a bridge to lung transplant. Several centers have instituted an approach that involves physical rehabilitation and ambulation for patients supported with ECMO. Recent reports describe the successful use of ambulatory ECMO in patients with chronic respiratory illnesses being bridged to lung transplant. We describe the first case of a previously healthy pediatric patient with acute respiratory failure successfully supported with ambulatory ECMO as a bridge to lung transplant after an unsuccessful bridge to recovery. Although there are challenges associated with awake and ambulatory ECMO in children, this strategy represents an exciting breakthrough and a potential paradigm shift in ECMO management for pediatric acute respiratory failure. Extracorporeal membrane oxygenation (ECMO) is an important therapeutic modality for patients with refractory respiratory failure. Despite extremely high predicted mortality in patients with refractory respiratory failure, survival for some populations supported with ECMO exceeds 70%. [1][2][3] However, in patients with irreversible pulmonary injury, lung transplant may be necessary. Traditional outcomes for ECMO patients bridged to lung transplant are poor, 4-7 but there are increasing reports of successful bridge to transplant using awake and ambulatory ECMO approaches in patients with chronic respiratory conditions. [8][9][10][11][12][13][14][15][16][17][18][19] We report the first successful bridge to lung transplant with ambulatory ECMO in a previously healthy pediatric patient with acute refractory respiratory failure. CASE DESCRIPTIONA 16-year-old, previously healthy, physically active girl presented to a community hospital with right lower lobe pneumonia and respiratory failure (Fig 1). Her condition deteriorated rapidly, prompting transfer to our quaternary care center for possible ECMO. Upon admission to our institution, the patient' s chest radiograph demonstrated diffuse infiltrates, bilateral pneumothoracies, and pneumomediastinum (Fig 2). She was immediately placed on high-frequency oscillatory ventilation, but because of an oxygen index persistently .40, frequent desaturations, and worsening air leak, venovenous ECMO was initiated via a 27-French double-lumen right internal jugular vein cannula (Avalon Laboratories, Rancho Domingo, CA) ∼30 hours after admission. For the next 4 weeks she needed deep pharmacologic sedation, intermittent neuromuscular blockade, and mechanical ventilation in conjunction with ECMO to maintain gas exchange. During this 4-week period, her air leak resolved, but she continued to have persistent acute respiratory distress syndrome and no improvement. A transbronchial biopsy revealed no infectious etiology, and the pathology results demonstrated organizing and proliferative diffuse alveolar damage and neutrophilic alveolitis...

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Section: E584mentioning

confidence: 99%

mentioning

confidence: 93%

Ambulatory ECMO as a Bridge to Lung Transplant in a Previously Well Pediatric Patient With ARDS

et al. 2014

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“…In fact, ECLS can potentially provide an adequate level of respiratory support for the patient's requirements, thereby minimizing the clinical impact of mechanical ventilation and increasing the chance to receive a successful LTx (8,9). Although suggested by a number of case reports (10)(11)(12), this hypothesis has never been systematically investigated.…”

Section: How To "Bridge" Patients To Lung Transplantationmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation as “Bridge” to Lung Transplantation: What Remains in Order to Make It Standard of Care?

Sorbo

Ranieri

Keshavjee

2012

Am J Respir Crit Care Med

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“…With the advent of pediatric transplant and the development of more reliable longerterm support devices (such as miniaturized ECMO circuits, centrifugal pumps, and ventricular assist devices) the prior resistance to use ECMO to support irreversible organ failure is increasingly being reconsidered. Use of ECMO to bridge patients to lung transplantation is increasingly being done at transplant centers (1)(2)(3)(4)(5)(6)(7). For these reasons, pediatric ECMO centers are finding themselves supporting patients with irreversible heart and/or lung failure for whom organ transplantation is a potentially life-saving intervention.…”

Section: Introductionmentioning

confidence: 99%

Development of a new interfacility extracorporeal membrane oxygenation transport program for pediatric lung transplantation evaluation

2017

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Pediatric lung transplantation is a life-saving intervention for children with irreversible endstage lung disease. Access to transplant can be limited by geographic isolation from a center or the presence of comorbidities affecting transplant eligibility. Extracorporeal membrane oxygenation (ECMO)-supported patients are an uncommon but historically high-risk cohort of patients considered for lung transplant. We report the development of a service at our center to provide transport services to our hospital for patients unable to wean from ECMO support at their local institution for the purpose of evaluation for lung transplantation by our program. We developed a process for pre-transport consultation by the lung transplant physician team, standardized hand-off tools and equipment lists, and procedures for transitioning patients to transport ECMO machinery. Four patients have been transported to date including fixed wing (FW) and helicopter transports. All patients were successfully transported with either none or minor complications. Transport of ECMO-supported patients is a feasible method to increase access of patients with irreversible lung injured patients to evaluation for lung transplant.

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

Cited by 102 publications

References 21 publications

Ambulatory ECMO as a Bridge to Lung Transplant in a Previously Well Pediatric Patient With ARDS

Ambulatory ECMO as a Bridge to Lung Transplant in a Previously Well Pediatric Patient With ARDS

Extracorporeal Membrane Oxygenation as “Bridge” to Lung Transplantation: What Remains in Order to Make It Standard of Care?

Development of a new interfacility extracorporeal membrane oxygenation transport program for pediatric lung transplantation evaluation

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