Critical Care Medicine-Pulmonary Disorders>>>>>Lung Transplantation, Complications, and VV ECMO
Question 2#

Which of the following patients on mechanical lung support in ICU is best suited for lung transplantation?

A. A 40-year-old male on “awake” VV ECMO for worsening idiopathic pulmonary fibrosis
B. A 25-year-old female on VV ECMO for ARDS due to sepsis and dialysis for AKI
C. A 47-year-old morbidly obese female (BMI-42) with severe restrictive lung disease on mechanical ventilation
D. A 76-year-old male with a recent history of bladder cancer resection on mechanical ventilation for acute exacerbation of end-stage COPD

Correct Answer is A


Correct Answer: A

Lung transplantation is considered for patients with end-stage lung disease who carry an expected 2-year mortality rate of greater than 50%. Expected likelihood of survival at 90 days and 5 years posttransplantation are also taken into consideration when selecting candidates for transplantation. Mechanical ventilation and/or extracorporeal life support (ECLS) are considered as “relative” contraindications for lung transplantation. At the same time, it is important to review and rule out other absolute and relative contraindications in a patient on mechanical support. There is a growing interest in using ECMO in awake, nonintubated patients as a bridging modality. “Awake” ECMO (A) offers the advantage of participation in physical therapy and rehabilitation before transplant. Successful transplantation with better outcomes has been reported with this strategy when compared to traditional mechanical support. 


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  3. Biscotti M, Gannon WD, Agerstrand C, et al. Awake extracorporeal membrane oxygenation as bridge to lung transplantation: a 9-year experience. Ann Thorac Surg. 2017;104:412-419.