Case Report
A 51-year-old female, diagnosed with COPD due to alpha-1 antitrypsin (A1AT) deficiency with a Lung Allocation Score (LAS) of 37 for double lung transplantation, presented to the emergency department with worsening shortness of breath while needing 8 L/min of oxygen via nasal cannula at home. The patient had a past 40-pack year smoking history. No other significant medical or family history was noted. She underwent venous-venous (VV) ECMO cannulation using Protek Duo RD™ as an intended bridge to lung transplant due to worsening hypoxemic and hypercapnic respiratory failure. The patient underwent ultrasound-guided percutaneous ECMO cannulation with Protek Duo RD™ 31 Fr dual lumen cannula in the right internal jugular vein. Using the Seldinger technique and a TTE, the 31 Fr venous cannula was inserted into the right internal jugular vein and advanced to the inferior vena cava (IVC) where the cannula was secured in place. She tolerated the procedure well and was extubated on high-flow nasal cannula post-ECMO transplantation day 2. Tracheostomy was performed following extubation. She was out of bed and ambulating post-ECMO cannulation day 2 following the ECMO implantation. During the first week post-ECMO transplantation, she started to have a bilateral spontaneous pulmonary hemorrhage. The transfusion of several FFPs, cryoprecipitates, as well as Factor 7, was needed to control the bleeding. The patient was sent to IR which performed coiling of intercostal arteries. Beginning with the bleeding, IV heparin was stopped. The pulmonary hemorrhage could be well controlled for the next five weeks. Six weeks after, she successfully underwent lung transplantation; she was decannulated POD 4. In the following days, she recovered well in our ICU and was discharged to rehab on POD 8.