Lung transplantation following 107 days of extracorporeal membrane oxygenation

Severe adult respiratory distress syndrome (ARDS) is associated with failure to maintain adequate gas exchange. There is increasing success using extracorporeal membrane oxygenation (ECMO) for respiratory failure; the longest reported surviving patient has been supported by ECMO for 57 days. At best about 50% wean from ECMO and should weaning fail their course is fatal. ECMO is generally considered to be a contraindication for successful lung transplantation. This report describes a patient maintained on ECMO for 107 days who underwent bilateral lung transplantation and weaned from organ-perfusion support. He survived for 351 days post-transplantation and died from Pseudomonas aeruginosa pneumonia. ECMO can be used for prolonged intervals to support patients with severe ARDS without complications that preclude lung transplantation. As ECMO use becomes more frequent, it becomes critical to determine criteria that would optimise patient selection for transplantation from ECMO.