Salam Shameen, Kotloff Robert, Garcha Puneet, Krishnan Sudhir, Joshi Dhruv, Grady Patrick, Duggal Abhijit
From the *Department of Chest diseases, St Vincent's Medical Institute and Research Centre, Erie, Pennsylvania; †Department of Pulmonary, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio; ‡Department of Pulmonary and Critical Care, Baylor University Medical Center, Baylor, Texas; §Department of Perfusion, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; and ¶Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
ASAIO J. 2017 Sep/Oct;63(5):e66-e68. doi: 10.1097/MAT.0000000000000450.
Venovenous extracorporeal membrane oxygenation (ECMO) has become a viable and increasingly utilized option for the treatment of refractory hypoxemia in severe acute respiratory distress syndrome (ARDS). However, options are limited for ARDS patients who fail to wean from ECMO. The high rates of infection, presence of extrapulmonary end organ damage, intensive care unit-acquired weakness, and high short-term mortality associated with ARDS are all significant hurdles that make lung transplantation a difficult prospect to consider. However, ECMO support has been used as a bridge to transplant in patients with other underlying chronic lung diseases. Our case illustrates the successful use of lung transplantation for a patient with no previous lung disease who developed refractory ARDS requiring protracted ECMO support. The use of ambulatory ECMO with early institution of physical therapy is an essential component in preparing such patients for successful transplantation.
静脉-静脉体外膜肺氧合（ECMO）已成为治疗严重急性呼吸窘迫综合征（ARDS）所致难治性低氧血症的一种可行且使用越来越频繁的选择。然而，对于无法从ECMO撤机的ARDS患者，选择有限。与ARDS相关的高感染率、肺外终末器官损伤的存在、重症监护病房获得性肌无力以及高短期死亡率，都是使得肺移植成为一个难以考虑的前景的重大障碍。然而，ECMO支持已被用作患有其他潜在慢性肺部疾病患者的移植桥梁。我们的病例说明了肺移植成功应用于一名既往无肺部疾病、发生难治性ARDS且需要长期ECMO支持的患者。使用可移动ECMO并早期开展物理治疗是使此类患者成功接受移植的重要组成部分。
