Successful Lung Transplantation After 213 Days of Extracorporeal Life Support: Role of Oxygenator-Right Ventricular Assist Device

Abstract

Venovenous extracorporeal membrane oxygenation (VV ECMO) can successfully support patients with refractory respiratory failure and is widely accepted as a bridge to recovery or bridge to transplantation. However, some problems hinder success. Recirculation, an innate complication of VV ECMO, hamper efficient oxygenation. Right ventricular (RV) failure secondary to respiratory failure is not uncommon and can be reversed by VV ECMO. But there are often times when RV failure gets worse, and since VV ECMO is no longer effective, additional measures are needed. Moreover, peripheral cannulation restricts active rehabilitation leading to weakness and weaning failure. Oxygenator-right ventricular assist device (OxyRVAD) refers any configuration that combines oxygenator and centrifugal pump. Compared to VV ECMO, it has advantages of hemodynamic support, elimination of recirculation, and facilitation of rehabilitation. In the present case, we overcame recirculation and impending RV failure by applying OxyRVAD to patient who was initially managed with VV ECMO. He underwent lung transplantation after about 6 months of OxyRVAD support with active rehabilitation, the longest maintenance period ever known.