Open AccessUpper‐Body Extracorporeal Membrane Oxygenation as a Strategy in Decompensated Pulmonary Arterial Hypertension
Author(s) -
Abrams Darryl C.,
Brodie Daniel,
Rosenzweig Erika B.,
Burkart Kristin M.,
Agerstrand Cara L.,
Bacchetta Matthew D.
Publication year - 2013
Publication title -
pulmonary circulation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.791
H-Index - 40
ISSN - 2045-8940
DOI - 10.4103/2045-8932.113178
Subject(s) - medicine , extracorporeal membrane oxygenation , decompensation , lung transplantation , transplantation , mechanical ventilation , pulmonary hypertension , rescue therapy , refractory (planetary science) , lung , salvage therapy , anesthesia , surgery , cardiology , chemotherapy , physics , astrobiology
Pulmonary arterial hypertension (PAH) is a disease with significant morbidity and mortality, particularly during an acute decompensation. We describe a single‐center experience of three patients with severe Group 1 PAH, refractory to targeted medical therapy, in which an extubated, nonsedated, extracorporeal membrane oxygenation (ECMO) strategy with an upper‐body configuration was used as a bridge to recovery or lung transplantation. All three patients were extubated within 24 hours of ECMO initiation. Two patients were successfully bridged to lung transplantation, and the other patient was optimized on targeted PAH therapy with subsequent recovery from an acute decompensation. The upper‐body ECMO configuration allowed for daily physical therapy, including one patient, who would otherwise have been unsuitable for transplantation, ambulating over 850 meters daily. This series demonstrates the feasibility of using ECMO to bridge PAH patients to recovery or transplantation while avoiding the complications of immobility and invasive mechanical ventilation.