Bridge to Lung Transplant With Trans-septal Extra-corporeal Membrane Oxygenation (ECMO) for Right Heart Failure From Pulmonary Hypertension

Patients that are listed for lung transplantation and have:

• PH defined as:

  • Group 1 Pulmonary arterial hypertension (PAH): Mean pulmonary artery pressure (PAP) ≥ 20 mm Hg, pulmonary capillary wedge pressure (PCWP) \< 15 mm Hg, and pulmonary vascular resistance (PVR) ≥ 3 Wood units
  • Group 3 PH is defined as the presence of chronic lung disease (CLD) and/or hypoxia and mean pulmonary artery pressure (PAP) ≥ 20 mm Hg.
• Secondary PH (WHO Group 3) or diagnosis of primary PH (WHO Group 1) (to include Eisenmenger syndrome).

• Failing right ventricle function defined as:

  • a cardiac (CI) index \< 2.2 L/min/m\^2 despite continuous infusion of high dose inotropes defined as:
  • Inhaled nitric oxide > 20 ppm and one of the following:
  • Dobutamine > 10 ug/kg/min x 15 minutes or
  • Milrinone > 0.5 ug/kg/min x 120 minutes or
  • Epinephrine > 0.5 ug/kg/min x 15 minutes or

  • Norepinephrine > 0.5 ug/kg/min x 15 minutes and have one of the following:

    1. central venous pressure (CVP) > 15 mm Hg

    2. global RV dysfunction on echocardiography defined as one of the following:

       1. a tricuspid annular plane systolic excursion score of \<14mm
       2. an RV diameter at base >42mm
       3. RV short-axis or midcavity diameter >35mm
  • Lactate greater than 3 mmol/L
  • Urine output \< 0.5 ml/kg/hour
• Age > 18 years old
• BMI \<35
• Informed consent signed by self or legally authorized representative.

Exclusion Criteria

• INTERMACS 1 patients (Critical cardiogenic shock patient who is "crashing and burning", has life-threatening hypotension and rapidly escalating inotropic or pressor support, with critical organ hypoperfusion often confirmed by worsening acidosis and lactate levels)
• End organ failure defined as: hepatic total bilirubin >5 mg/dL based on lab data within 24 hours prior to transseptal ECMO initiation; renal creatinine >4 mg/dLbased on lab data within the 24 hours prior to transseptal ECMO initiation
• Evidence of acute neurologic injury
• Active infection defined as two of the following WBC >12,500, positive blood culture, fever
• RA thrombus
• Thrombolysis within the previous 30 days or known existing coagulopathy such as thrombocytopenia or hemoglobin diseases such as sickle cell anemia or thalassemia
• Right heart failure from isolated pulmonary embolism
• Right heart failure from coronary artery disease or from left heart failure (WHO Type 2)
• Congenital forms of pulmonary hypertension such as tetralogy of fallot or pulmonary vein stenosis.