Successful Extracorporeal Membrane Oxygenation Bridge to Lung Transplant With a Patient Transported From Hawaii to Nashville, Tennessee

This report by Adjei and colleagues describes a prolonged course of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation.  A 58-year-old woman in Hawaii developed severe acute respiratory distress syndrome secondary to influenza A pneumonitis, necessitating the initiation of ECMO. Her hospital course was complicated by irreversible lung injury and profound deconditioning, leaving her unable to ambulate more than 10 feet. After being declined by more than 20 transplant centers, she was ultimately accepted at Vanderbilt University. Remarkably, she was airlifted 4,300 miles from Honolulu, Hawaii, USA, to Nashville, Tennessee, USA, while supported on ECMO.  The authors detail the structured rehabilitation protocol that enabled her to ambulate 700 feet prior to transplantation. After 126 days on ECMO, she underwent successful lung transplantation and was discharged on postoperative day 23.  This case highlights that in select patients with end-stage lung disease, ECMO can be used as a bridge to transplantation.