Use of veno-pulmoarterial ECMO to manage differential oxygenation in a lung transplant candidate

A 44-year-old male with pulmonary sarcoidosis related interstitial lung disease and pulmonary hypertension was admitted for pre-transplant evaluation. During hospitalization, he developed cardiac arrest due to worsening respiratory failure and was immediately placed on veno-arterial (VA) extracorporeal membrane oxygenation (ECMO). Despite initial improvement, he developed differential oxygenation, which was managed by converting the support to veno-venoarterial (VVA) ECMO. However, pulmonary artery pressure increased, placing a greater load on the right ventricle, and oxygenation remained inadequate, leading to further optimization of the ECMO settings. The support was switched to veno-pulmoarterial (VPA) ECMO, which improved oxygenation and, through the combined effects of oxygenation and circulatory support, stabilized his condition. After 24 days of ECMO support, the patient underwent successful lung transplantation. His postoperative course was uncomplicated, and he was discharged on postoperative day 32. Over the subsequent 2 years of follow-up, he has remained active, independent of oxygen, and free of functional limitations.