ECMO cannulation strategy for pulmonary hypertension: an alternative approach to traditional Veno-Arterial ECMO

Pulmonary arterial hypertension (PAH) is a severe disease characterized by a progressive increase of pulmonary pressure and resistance, leading to right heart failure. PAH is commonly diagnosed at a late stage of the disease and is associated with progressive clinical deterioration and premature death. The treatment of PAH continues to be complicated, especially when considering treatment with extracorporeal membrane oxygenation (ECMO). A case is described that involves a heart failure patient placed on a ventricular assist device as a bridge to heart transplantation with recent onset of PAH. The goal was to rest the entire pulmonary circulation during ECMO while allowing the ventricular assist device to continue to function using a modified veno-arterial (VA) cannulation strategy. This configuration allowed the patient's right heart to rest and ultimately recover while the left ventricular assist device (LVAD) maintained systemic perfusion, successfully allowing the patient to maintain a United Network for Organ Sharing (UNOS) status 1a listing.