Refractory traumatic bronchopleural fistula: Is extracorporeal membrane oxygenation the new gold standard?

INTRODUCTION: A refractory bronchopleural fistula leading to respiratory failure in a trauma patient is one of the most challenging pathologies to manage in one of the most challenging patient populations. Modern equipment and techniques have decreased and perhaps even eliminated the need for anticoagulation with ECMO, and it is finding an important niche in saving this patient population from refractory hypoxia. We review here our experience with three refractory traumatic bronchopleural fistulae utilizing venovenous ECMO as the primary treatment modality. MATERIAL AND METHODS: Retrospective chart review of three cases of refractory traumatic bronchopleural fistula treated primarily with ECMO and an ultra-lung protective strategy. RESULTS: The use of an ultra-lung protective strategy with ECMO allowed sealing of all three bronchopleural fistula. CONCLUSIONS: Traumatic bronchopleural fistulae require careful thought and early utilization of lung protective strategies to facilitate healing of the injured lung.

DCD and DBD lung transplantation optimized by ex vivo perfusion: What to do when the pump fails.

BACKGROUND: Ex vivo perfusion is a safe and feasible method of assessing and using high-risk donor organs. AIM: We describe a case of successfully ex vivo treated and transplanted human lung allografts. METHODS: Donor human lungs were assessed using ex vivo, our trouble shooting protocol allowed safe recovery. RESULTS: We successfully implanted our ex vivo treated organs.

In vivo resuscitation, perfusion, and transplantation of a porcine cardiac allograft donated after circulatory death.

OBJECTIVES: To test the feasibility of a novel method of heart donation under circulatory death criteria that allows precardiectomy donor heart assessment. MATERIALS AND METHODS: This is a translational study utilizing 16 female Yorkshire pigs in a series of eight heart transplant procedures under a circulatory death model. RESULTS: Successful resuscitation of the donor hearts occurred in seven out of eight animals. All seven of these hearts were deemed to have good function and were successfully transplanted. In the animal in which donor heart resuscitation was not successful, the transplant was aborted, and a left ventricular assist device (LVAD) was placed in the recipient's heart. CONCLUSION: This animal study demonstrates the feasibility of using this novel technique for resuscitation and precardiectomy evaluation of donated after circulatory death hearts. For those donor hearts without adequate function, an LVAD can be safely implanted as a "bail-out" option. The limitations of this technique are the patient population to which it can be applied (only those patients eligible and consented for LVAD).

Rescue therapy for hypercapnia due to high PEEP mechanical ventilation in patients with ARDS and renal failure.

Extracorporeal removal of carbon dioxide in patients experiencing severe hypercapnia due to lung protective mechanical ventilation was first described over four decades ago. There have been many devices developed and described in the interim, many of which require additional training, resources, and staff. This manuscript describes a readily available and relatively simple adjunct that can provide partial lung support in patients with acute respiratory distress syndrome complicated by severe hypercapnia and acute kidney injury requiring dialysis.