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.