A man with idiopathic pulmonary fibrosis (IPF) was kept alive and his blood oxygenated for more than a year while waiting for a lung transplant using a type of extracorporeal membrane oxygenation (ECMO) called veno-venous ECMO — a procedure usually limited in use to about two weeks, researchers in Japan report.
They estimate that one year is about the maximum length of time that ECMO can be used to help people in respiratory failure.
The case study, “Idiopathic pulmonary fibrosis patient supported with extracorporeal membrane oxygenation for 403 days while waiting for a lung transplant: a case report,” was published in the journal Respiratory Medicine Case Reports.
ECMO is a life support technique used to oxygenate the blood of patients whose heart and lungs are no longer able to function properly. In this specific case, the medical team used veno-venous ECMO (VV ECMO), in which oxygenated blood is returned to a patient’s vein and mixed with the deoxygenated blood being carried by the vein.
On average, VV ECMO is used with adults in acute respiratory failure for 10.5 to 13.5 days. But not all patients on VV ECMO recover in that period, and that prolonged use is known — including cases of use for more than 100 and 200 days.
Even so, researchers don’t know yet how long is it feasible to submit a patient to VV ECMO.
Scientists here report the case of a 50-year-old Japanese man with acute IPF exacerbation, who was kept on VV ECMO for 403 days while waiting for a lung transplant, until complications made continued use impossible.
Admitted to intensive care due to hypoxia (low blood-oxygen levels), the patient was mechanically ventilated and ECMO initiated. His condition gradually improved and, on day 38, mechanical ventilation was discontinued.
The patient’s heart and lungs were monitored for 304 days, and medication and oxygen levels were adjusted according to changes in his condition.
In total, the membrane oxygenator was changed 23 times and the cannula providing oxygen to the patient was replaced 10 times, without complications.
On day 305, a blood clot (thrombus) blocked the vein where the cannula was inserted, hampering further changes of the cannula. His physicians used the same cannula but, on day 371, the patient went into septic shock — overall organ injury or damage due to infection.
The team attempted to change the cannula again, but an echocardiography showed all possible veins occluded by thrombus. As the patient remained relatively stable and alert, doctors decided to stop ECMO support on day 403 due to “destruction of the access site.” The man’s conditioned declined, and he died soon thereafter.
Overall, this study showed that it is possible to maintain patients with acute respiratory complications on ECMO for an extended period of time.
“We managed a patient with acute exacerbation of idiopathic pulmonary fibrosis on ECMO in an awake state for approximately one year without life-threatening complications,” the researchers wrote.
But they emphasized that ECMO likely has a limited duration of safe use.
“Although device improvements have allowed for longer ECMO support, we hypothesize that the maximum duration is limited to one year because of destruction of the access site, pulmonary hypertension, and infection,” they concluded.
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