Upper-body extracorporeal membrane oxygenation as a strategy in decompensated pulmonary arterial hypertension
A 34-year-old woman listed for lung transplantation with idiopathic PAH, status post-atrial septostomy, receiving sildenafil and intravenous treprostinil, with WHO functional Class III symptoms, presented with severe deconditioning, worsening right heart failure, and acute renal failure despite inotropes and diuresis, making her an inappropriate transplant candidate. Venoarterial ECMO was initiated to optimize her for transplantation, with the same configuration as in Case 2. The patient was extubated in the operating room, and all intravenous PAH therapies were discontinued within 24 hours. Her renal failure and anasarca resolved within 48 hours, enabling her to ambulate over 850 m daily. Low-grade bleeding from an arterial cannula defect, which caused a hematoma and brachial plexopathy, was repaired at the bedside. On ECMO Day 19, she underwent lung transplantation and septostomy closure. She was discharged home one month after transplantation and has been living independently.