Bridge Using the Hemolung System for Re-Do Double Lung Transplant In Situs Inversus Patient

Abstract

IntroductionExtracorporeal life support (ECLS) use in redo-lung transplant is limited due to poor outcomes. Extracorporeal circulation with a single cannula provides the advantage of mobility and effective rehabilitationn in patients with an expected long run. The Hemolung veno-venous extracorporeal carbon dioxide removal (ECCO2R) system allows for adequate removal of carbon dioxide with a small French double lumen catheter.Case ReportA 29-year-old female with Kartagener syndrome and complete situs inversus underwent a double lung transplant for end stage lung disease. Her postoperative course was uneventful. After an aspiration event, she experienced a severe and persistent decline in her lung function within her first year. She ultimately was hospitalized requiring mechanical ventilation and a tracheostomy. The patient had primarily hypercapnic respiratory failure with radiographic signs of CLAD. The need for a high respiratory rate led to increased calory consumption with a significant impact on her BMI. To optimize her nutritional status and muscle strength before re-do lung transplantation, we decided to bridge her with ECLS. The use of an Avalon cannula was limited by her anatomy as the outflow jet will point against the atrial wall. Dual site cannulation was deemed suboptimal to preserve mobility. We decided to proceed with a Hemolung after emergency FDA authorization. A dual-lumen 15.5Fr catheter was placed via the left IJ into the superior vena cava. As we normalized her CO2 by active ECCO2R removal, we were able to reduce her ventilatory needs, improve her nutritional status and mobility. She was listed and underwent an uneventful redo-double lung transplant with cardiopulmonary support. The patient is 200 days out and doing well.SummaryThis experience demonstrates that ECCO2R technologies can be safely and effectively used to bridge lung transplant patients with hypercapnic respiratory failure in which anatomical challenges limit cannulation options. Extracorporeal life support (ECLS) use in redo-lung transplant is limited due to poor outcomes. Extracorporeal circulation with a single cannula provides the advantage of mobility and effective rehabilitationn in patients with an expected long run. The Hemolung veno-venous extracorporeal carbon dioxide removal (ECCO2R) system allows for adequate removal of carbon dioxide with a small French double lumen catheter. A 29-year-old female with Kartagener syndrome and complete situs inversus underwent a double lung transplant for end stage lung disease. Her postoperative course was uneventful. After an aspiration event, she experienced a severe and persistent decline in her lung function within her first year. She ultimately was hospitalized requiring mechanical ventilation and a tracheostomy. The patient had primarily hypercapnic respiratory failure with radiographic signs of CLAD. The need for a high respiratory rate led to increased calory consumption with a significant impact on her BMI. To optimize her nutritional status and muscle strength before re-do lung transplantation, we decided to bridge her with ECLS. The use of an Avalon cannula was limited by her anatomy as the outflow jet will point against the atrial wall. Dual site cannulation was deemed suboptimal to preserve mobility. We decided to proceed with a Hemolung after emergency FDA authorization. A dual-lumen 15.5Fr catheter was placed via the left IJ into the superior vena cava. As we normalized her CO2 by active ECCO2R removal, we were able to reduce her ventilatory needs, improve her nutritional status and mobility. She was listed and underwent an uneventful redo-double lung transplant with cardiopulmonary support. The patient is 200 days out and doing well. This experience demonstrates that ECCO2R technologies can be safely and effectively used to bridge lung transplant patients with hypercapnic respiratory failure in which anatomical challenges limit cannulation options.