open access

Vol 89, No 3 (2021)
Case report
Submitted: 2020-12-09
Accepted: 2021-02-27
Published online: 2021-06-30
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First lung transplantation as a treatment of a patient supported with extracorporeal membrane oxygenation (ECMO) after COVID-19 in Poland

Maciej Urlik1, Konstanty Szułdrzyński23, Tomasz Stącel1, Mirosław Nęcki1, Piotr Bielański3, Miłosz Jankowski23, Remigiusz Antończyk1, Magdalena Latos1, Anna Pióro4, Marian Zembala1, Krzysztof Pyrć5, Marek Ochman1
DOI: 10.5603/ARM.a2021.0042
·
Pubmed: 34196386
·
Adv Respir Med 2021;89(3):328-333.
Affiliations
  1. Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland
  2. Jagiellonian University Medical College, Faculty of Medicine, Krakow, Poland
  3. The Centre for Extracorporeal Therapies University Hospital Krakow, Krakow, Poland
  4. Department of Cardiac Anaesthesia and Intensive Care SUM, Silesian Centre for Heart Diseases, Zabrze, Poland
  5. Virogenetics Laboratory of Virology, Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland

open access

Vol 89, No 3 (2021)
CASE REPORTS
Submitted: 2020-12-09
Accepted: 2021-02-27
Published online: 2021-06-30

Abstract

A 44-year-old male with no history of underlying diseases was referred to academic hospital due to ARDS with confirmed SARSCoV-2 infection after 7 days of mechanical ventilation. Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) was initiated as no improvement was noted in prone position. Mechanical ventilation was continued with TV of 3–4 mL/kg. A gradual decline of static lung compliance was observed from baseline 35 mL/cm H20 to 8 mL/cm H2O. The chest CT scan revealed extensive ground-glass areas with a significant amount of traction bronchiectasis after 3 weeks since admission. When the patient was negative for SARS-CoV-2 during the 4th week of ECMO, the decision to perform an emergency lung transplantation (LTx) was made based on the ongoing degradation of lung function and irreversible damage to lung structure. The patient was transferred to the transplant center where he was extubated, awaiting the transplant on passive oxygen therapy and ECMO. Double lung transplantation was performed on the day 30th of ECMO. Currently, the patient is self-reliant. He does not need oxygen therapy and continues physiotherapy.
ECMO may be life-saving in severe cases of COVID-19 ARDS but some of these patients may require LTx, especially when weaning proves impossible. VV ECMO as a bridging method is more difficult but ultimately more beneficial due to insufficient number of donors, and consequently long waiting time in Poland.

Abstract

A 44-year-old male with no history of underlying diseases was referred to academic hospital due to ARDS with confirmed SARSCoV-2 infection after 7 days of mechanical ventilation. Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) was initiated as no improvement was noted in prone position. Mechanical ventilation was continued with TV of 3–4 mL/kg. A gradual decline of static lung compliance was observed from baseline 35 mL/cm H20 to 8 mL/cm H2O. The chest CT scan revealed extensive ground-glass areas with a significant amount of traction bronchiectasis after 3 weeks since admission. When the patient was negative for SARS-CoV-2 during the 4th week of ECMO, the decision to perform an emergency lung transplantation (LTx) was made based on the ongoing degradation of lung function and irreversible damage to lung structure. The patient was transferred to the transplant center where he was extubated, awaiting the transplant on passive oxygen therapy and ECMO. Double lung transplantation was performed on the day 30th of ECMO. Currently, the patient is self-reliant. He does not need oxygen therapy and continues physiotherapy.
ECMO may be life-saving in severe cases of COVID-19 ARDS but some of these patients may require LTx, especially when weaning proves impossible. VV ECMO as a bridging method is more difficult but ultimately more beneficial due to insufficient number of donors, and consequently long waiting time in Poland.

Get Citation

Keywords

lung transplantation, COVID-19, SARS-CoV-2, extracorporeal membrane oxygenation

About this article
Title

First lung transplantation as a treatment of a patient supported with extracorporeal membrane oxygenation (ECMO) after COVID-19 in Poland

Journal

Advances in Respiratory Medicine

Issue

Vol 89, No 3 (2021)

Article type

Case report

Pages

328-333

Published online

2021-06-30

DOI

10.5603/ARM.a2021.0042

Pubmed

34196386

Bibliographic record

Adv Respir Med 2021;89(3):328-333.

Keywords

lung transplantation
COVID-19
SARS-CoV-2
extracorporeal membrane oxygenation

Authors

Maciej Urlik
Konstanty Szułdrzyński
Tomasz Stącel
Mirosław Nęcki
Piotr Bielański
Miłosz Jankowski
Remigiusz Antończyk
Magdalena Latos
Anna Pióro
Marian Zembala
Krzysztof Pyrć
Marek Ochman

References (12)
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  2. Gulack BC, Hirji SA, Hartwig MG. Bridge to lung transplantation and rescue post-transplant: the expanding role of extracorporeal membrane oxygenation. J Thorac Dis. 2014; 6(8): 1070–1079.
  3. Peek G, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. The Lancet. 2009; 374(9698): 1351–1363.
  4. Mehta P, McAuley D, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. The Lancet. 2020; 395(10229): 1033–1034.
  5. Grasselli G, Greco M, Zanella A, et al. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med. 2020; 180(10): 1345–1355.
  6. George P, Wells A, Jenkins R. Pulmonary fibrosis and COVID-19: the potential role for antifibrotic therapy. The Lancet Respiratory Medicine. 2020; 8(8): 807–815.
  7. Marini J, Gattinoni L. Management of COVID-19 respiratory distress. JAMA. 2020; 323(22): 2329–2330.
  8. Cypel M, Keshavjee S. When to consider lung transplantation for COVID-19. The Lancet Respiratory Medicine. 2020; 8(10): 944–946.
  9. Chen JY, Qiao K, Liu F, et al. Lung transplantation as therapeutic option in acute respiratory distress syndrome for coronavirus disease 2019-related pulmonary fibrosis. Chin Med J (Engl). 2020; 133(12): 1390–1396.
  10. Han W, Zhu M, Chen J, et al. Lung transplantation for elderly patients with end-stage COVID-19 pneumonia. Ann Surg. 2020; 272(1): e33–e34.
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  12. Lang C, Jaksch P, Hoda M, et al. Lung transplantation for COVID-19-associated acute respiratory distress syndrome in a PCR-positive patient. The Lancet Respiratory Medicine. 2020; 8(10): 1057–1060.

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