scholarly journals Pre-Anesthesia Extracorporeal Membrane Oxygenation in Two Lung Transplant Recipients with Severe Pulmonary Hypertension

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Liu Minqiang ◽  
Gao Hong ◽  
Chen Jingyu ◽  
Wang Yanjuan ◽  
Xu Bo ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Lung Transplant ◽  
Anesthesia Induction ◽  
Transplant Recipients ◽  
Cardiorespiratory Failure ◽  
Membrane Oxygenation ◽  
Cardiopulmonary Support ◽  
Pulmonary Arterial ◽  
Lung Transplant Recipients ◽  
Severe Pulmonary Arterial Hypertension

Extracorporeal membrane oxygenation (ECMO) is a widely used cardiopulmonary support method that is usually implemented after anesthesia during the period of lung transplantation (LTx). In severe pulmonary arterial hypertension (PAH) patients, however, anesthesia induction is a high-risk phase and can result in severe cardiorespiratory failure. Herein, we describe two severe PAH patients who received ECMO support before anesthesia and whose preoperative evaluations indicated that the risk was too high to safely survive the anesthesia induction period before LTx. The strategy was successful, and in both patients, hemodynamics was stable and no ECMO-related complications occurred.

scholarly journals Palliative balloon atrial septostomy in two pediatric patients with severe pulmonary arterial hypertension requiring extracorporeal membrane oxygenation support

2020 ◽  
Vol 10 (3) ◽  
pp. 004947552095973
Author(s):  
Samantha L. Brackett ◽  
Nina Deutsch ◽  
Chinwe Unegbu
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Extracorporeal Membrane Oxygenation ◽  
Arterial Hypertension ◽  
Pediatric Patients ◽  
Case Series ◽  
Balloon Atrial Septostomy ◽  
Membrane Oxygenation ◽  
Atrial Septostomy ◽  
Pulmonary Arterial ◽  
Severe Pulmonary Arterial Hypertension

Pulmonary arterial hypertension is a pernicious disease with a diverse etiology in the pediatric population. Despite the increased availability of drug therapies, pulmonary arterial hypertension continues to cause significant morbidity and mortality. In pediatric patients with severe pulmonary arterial hypertension who have failed medical therapy, a few studies have demonstrated the role of balloon atrial septostomy as a bridge to lung transplantation or a means of improving symptomatology. However, no data exists on the utilization of balloon atrial septostomy as a palliative intervention to wean from extracorporeal membrane oxygenation (ECMO) when all other therapies are exhausted. Here we describe a case series of two pediatric patients with severe pulmonary arterial hypertension, requiring ECMO support, who were successfully weaned from ECMO following balloon atrial septostomy.

Mobilization of Patients Receiving Extracorporeal Membrane Oxygenation Before Lung Transplant

2021 ◽  
Vol 41 (4) ◽  
pp. 39-45
Author(s):  
Kelly Patrick ◽  
Anthony Adams
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Lung Transplant ◽  
Early Mobilization ◽  
Health Records ◽  
Membrane Oxygenation ◽  
Standardized Protocol ◽  
Cardiopulmonary Support ◽  
Hospital Patients ◽  
Therapy Sessions ◽  
Careful Assessment

Background Extracorporeal membrane oxygenation is increasingly used to provide cardiopulmonary support to patients awaiting lung transplant. Although studies have shown that these patients benefit from early mobilization, the care team often has concerns about related complications, particularly for patients requiring femoral cannulation. Objective To assess the safety of mobilizing patients receiving extracorporeal membrane oxygenation before lung transplant using a standardized mobility protocol. Methods A retrospective review was performed of the electronic health records of patients receiving extracorporeal membrane oxygenation before or immediately after lung transplant who were mobilized according to a standardized protocol from April through October 2018. The setting was an 18-bed cardiothoracic intensive care unit in a Magnet-designated teaching hospital. Patients were helped to ambulate by an interdisciplinary team, with careful assessment for any related complications. Results During the study period, 37 patients received extracorporeal membrane oxygenation, and 9 were mobilized. Two hundred forty-two therapy sessions were conducted involving 47 700 feet of ambulation. Patients experienced the following complications: chugging (1 patient), decrease in flow rate (2 patients), bleeding at the cannula site (2 patients), neck hyperextension (1 patient), fear/anxiety (1 patient), and shortness of breath (2 patients). Bleeding and neck hyperextension led to discontinuation of therapy until the problems were resolved. No changes were made to the protocol. Conclusions Patients receiving extracorporeal membrane oxygenation before lung transplant, including those with femoral cannulation, can be mobilized safely with the use of an interprofessional ambulation protocol. Further evaluation is indicated, including research on clinical outcomes.

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