Rescuing lung transplant candidates with rapidly progressive interstitial lung disease who fail V-V ECMO: A case series of dual veno-arterial and veno-venous extracorporeal membrane oxygenation circuits

Background: Providing adequate, awake and ambulatory mechanical circulatory support to patients with rapidly progressive advanced intersitial lung disease (ILD) remains challenging. In a subset of ILD patients with refractory hypoxemia or hemodynamic instability, despite optimal veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) support, the addition of a veno-arterial (V-A) ECMO circuit may avoid the need for mechanical ventilation and protect against right ventricular dysfunction and subsequent end-organ dysfunction. Methods: We herein report the first case series of three patients with ILD who received dual VV-VA ECMO support as a bridge to transplantation. Results: All patients survived until lung transplantation 2 to 8 days after V-A ECMO initiation and had an unremarkable post-transplant recovery. Conclusion: Although the addition a second ECMO circuit is a complex and resource-intensive strategy, it is a feasible approach to stabilze a subset of ILD patients who are indequately supported with V-V ECMO.