SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters II
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: Pulmonary arterial hypertension (PAH) is a rapidly progressive disease with significant morbidity and mortality, particularly when refractory to medical therapy or during acute decompensation; these patients may require lung transplantation but often die waiting. We describe a single center experience of 3 patients with severe group 1 PAH, refractory to targeted medical therapy, in which awake ECMO was successfully used as a bridge to recovery or lung transplantation.
METHODS: Patient #1, a 22 year-old woman with severe PAH and an atrial septal defect (ASD), had progressive right heart failure and hypoxemic respiratory failure associated with hemoptysis, despite maximal PAH therapy. Venovenous ECMO was initiated with catheter-directed blood flow across the ASD via the internal jugular vein as bridge to transplantation. Patient #2, a 22 year-old woman with surgically corrected transposition of the great vessels and PAH, developed an acute respiratory infection leading to refractory hypoxemic respiratory failure. She was placed on upper-body venoarterial ECMO as bridge to recovery. Patient #3, a 34 year-old woman with PAH and decompensated right heart failure despite maximal PAH therapy, was placed on upper-body venoarterial ECMO as bridge to transplantation.
RESULTS: All 3 patients were extubated within 24 hours of ECMO initiation. The upper-body ECMO configuration allowed for daily physical therapy, including ambulation of up to 2400 feet. Patient #1 underwent lung transplantation on ECMO day #7 and is now 18 months post-transplant and fully independent. Patient #2 recovered from her acute illness, was decannulated after 8 days using IV epoprostenol to bridge off ECMO, and remains only on oral therapy. Patient #3 underwent lung transplantation on ECMO day #19 and is expected to fully recover.
CONCLUSIONS: We demonstrate the feasibility of awake upper-body ECMO to bridge PAH patients to recovery or lung transplantation when optimal medical therapy fails. An upper-body configuration facilitates physical therapy, preventing deconditioning and optimizing transplant candidacy.
CLINICAL IMPLICATIONS: Awake ECMO should be considered in cases of refractory PAH in whom recovery or transplantation is anticipated.
DISCLOSURE: Daniel Brodie: Grant monies (from industry related sources): Daniel Brodie has research support from Maquet Cardiovascular including travel awards to research meetings
Matthew Bacchetta: Grant monies (from industry related sources): Matthew Bacchetta has research support from Maquet Cardiovascular including travel awards to research meetings
The following authors have nothing to disclose: Darryl Abrams, Erika Rosenzweig, Cara Agerstrand, Joshua Sonett
No Product/Research Disclosure InformationColumbia University Medical Center, New York, NY