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Case Reports
. 2013 Apr;3(2):432-5.
doi: 10.4103/2045-8932.113178.

Upper-body extracorporeal membrane oxygenation as a strategy in decompensated pulmonary arterial hypertension

Darryl C Abrams  1 , Daniel Brodie, Erika B Rosenzweig, Kristin M Burkart, Cara L Agerstrand, Matthew D Bacchetta
Affiliations
Case Reports

Upper-body extracorporeal membrane oxygenation as a strategy in decompensated pulmonary arterial hypertension

Darryl C Abrams et al. Pulm Circ. 2013 Apr.

Abstract

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.

Keywords: ambulatory; extracorporeal membrane oxygenation; extubated; pulmonary arterial hypertension; upper-body.

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Conflict of interest statement

Conflict of Interest: Drs. Brodie and Bacchetta receive research support from and do research consulting for Maquet Cardiovascular. They do not receive personal remuneration for these activities although travel expenses are paid and the university receives remuneration. They also participated in a one-time paid focus group for Maquet Cardiovascular. There are no other conflicts of interest to report.

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