Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) as Treatment for Transfusion-Related Acute Lung Injury

Transfusion-related acute lung injury (TRALI) manifests as acute lung injury and hypoxemia occurring several hours after transfusion. While treatment typically involves cessation of the transfusion and supportive measures, severe cases may necessitate mechanical ventilation, including the initiation of veno-venous extracorporeal membrane oxygenation (VV-ECMO). In this case, we present a severe instance of TRALI after a blood transfusion during a femoral endarterectomy. The patient's condition deteriorated intra-operatively post-transfusion, marked by worsening hypoxia and ventilator dyssynchrony, necessitating increased sedation, paralytics, and inhaled nitric oxide. With the patient's respiratory status continuing to decline, VV-ECMO was initiated, resulting in complete recovery of lung function. Our report underscores the rare recovery of TRALI with ECMO, highlighting its efficacy during the acute phase of a transfusion reaction.