Extracorporeal life support for severe heart failure in a diffuse panbronchiolitis patient awaiting lung transplant:...

A 55-year-old woman with chronic respiratory failure due to diffuse panbronchiolitis, on a lung transplant waitlist, developed acute left ventricular failure with an ejection fraction of 18%. Although cardiac reversibility was uncertain, it was considered potentially reversible and transplant eligibility was judged to be maintainable; therefore, veno-arterial extracorporeal membrane oxygenation with Impella was initiated as extracorporeal life support (ECLS), with combined support selected to prevent left ventricular distension and provide circulatory stabilization. Cardiac function improved, and she was successfully weaned from ECLS, subsequently undergoing bilateral lung transplantation. In this case, the decision to initiate ECLS was determined not only by the need for life-saving circulatory support but also by the simultaneous assessment of cardiac reversibility and the feasibility of maintaining transplant eligibility. This case highlights the importance of integrating these considerations in selecting appropriate candidates for ECLS as a bridge-to-decision.