Extracorporeal membrane oxygenation as a bridge to lung transplantation following paraquat poisoning

Paraquat poisoning contributes to nearly 14.4% of the total poisoning cases in southern India. When ingested, it leads to renal and liver damage. It accumulates in alveolar cells and through reactive oxygen species damage, it can lead to pulmonary fibrosis. Once pulmonary fibrosis is established, the ensuing respiratory failure is irreversible. The previously reported duration of extracorporeal membrane oxygenation (ECMO) to support the respiratory function in paraquat poisoning, as a bridge to lung transplantation, ranged between 1 and 2 days. We demonstrate the use of long-term awake veno-venous (VV) ECMO in two patients (70 and 67 days), after paraquat poisoning as a bridge to lung transplantation. We describe the advantages of awake ECMO in patients requiring extended ECMO support mainly in the form of nutritional, physical, and psychiatric rehabilitation. This is of importance in these patients, and awake ECMO provides an excellent method to achieve an optimum physical status prior to lung transplantation.