Bi-Caval Dual Lumen Catheter for Veno-Venous Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation for Cystic Fibrosis

Abstract

Purpose Extracorporeal Membrane Oxygenation (ECMO) is now considered as a useful technique for severe respiratory failure in end stage cystic fibrosis (CF) patients. Muscle deconditioning, sepsis and multiple organ failure must be avoided to allow lung transplantation (LT). We evaluate the feasibility of “awake” ECMO and outcome of a strategy based on systematic double lumen bi-caval cannula (DLC) for V-V ECMO as a bridge to LT. Methods and Materials From 06/10 to 06/12 we systematically used a DLC (Avalon®) for V-V ECMO as a bridge to LT, in a single institution. Insertion in the right jugular vein was performed with fluoroscopic or transoesophageal echocardiographic guidance. CF patients were considered for this strategy in the absence of general sepsis or extra respiratory organ failure. Results 10 CF patients (7 females, median aged 24 years, range 17-32) were included. Before ECMO, patients were hypercapnic (100+-10mmHg) and hypoxemic (PaO2/FiO2: 133+−91mmHg) despite optimization of mechanical ventilation. Patients received antibiotics and steroids. DLC implantation was successful in 8. In the 2 other cases failure was related to intrathoracic venous stenosis secondary to previous central access port and a conventional V-V ECMO was used. Gas exchange correction was rapidly achieved. 6 patients could be awakened with spontaneous breathing. Physical therapy, active rehabilitation and proper alimentation were then easily continued. No cannula related complications were observed. All patients were transplanted within 3.4+−1.7 days. Intraoperatively, we systematically switched V-V to Veno-Arterial ECMO. 5/10 required ECMO support after transplantation during 3.4+−2.8 days. The mean lengths of mechanical ventilation and ICU stay were respectively 8+−12 days and 17+/−14 days. 3 patients died at day 41, 59 and 61 from septic complications. Conclusions A strategy based on DLC for V-V ECMO is suitable as a bridge for LT in end stage CF patients.