Extracorporeal membrane oxygenation after lung or heart-lung transplantation

Extracorporeal membrane oxygenation (ECMO) has proven to be life-saving in cases of reversible lung injury. One potential application of ECMO in the field of lung transplantation is the support of the patient with acute pulmonary failure immediately after transplantation until the transplanted lung has resumed satisfactory gas transfer function. The authors have had experience with ECMO in three patients who have had acute pulmonary failure and inadequate oxygenation after bilateral single lung (BSLT) or heart-lung transplantation (HLT). Patient 1 is a 47-year-old woman with alpha-1 antitrypsin deficiency who underwent a HLT and experienced fulminant pulmonary edema secondary to an intraoperative coagulopathy that required massive transfusion. Patient 2 was a 45-year-old man with a patent ductus arteriosus (PDA) that resulted in Eisenmenger's complex. Patient 2 underwent an HLT and experienced acute pulmonary failure. Patient 3 is a 58-year-old woman with an atrial septal defect (ASD) and pulmonary hypertension who underwent repair of the ASD and BSLT. Patient 3 experienced complete atelectatic collapse of the right lung and pulmonary edema of the left lung. These three patients had PO₂ measurements of 23, 39, and 23 mmHg, respectively, despite receiving 100% FiO₂ and maximal ventilatory support. All three patients were subsequently placed on ECMO and had improvement of their oxygenation. Patients 1 and 3 were successfully weaned from ECMO and extubated on post-operative day (POD) 21 and 16, respectively. Patient 2 had significant improvement in oxygenation but died on POD 4 of persistent mediastinal hemorrhage. This recent experience demonstrates that ECMO can be a life-saving intervention in patients who sustain acute lung injury after lung or HLT.