Femoral venoarterial extracorporeal membrane oxygenation for severe reimplantation response after lung transplantation

Severe pulmonary reimplantation response after lung transplantation is not very common, although the mortality can be high. We present a patient who d eveloped an extremely severe reperfusion injury after bilateral lung transp lantation. Because of severe hypoxia and hemodynamic instability, despite a ggressive ventilator settings, venoarterial extracorporeal membrane oxygena tion (ECMO) was instituted using the femoral approach at the bedside. Durin g ECMO, the patient developed a thoracic wall hematoma that was treated wit h transfusion alone. After 50 h of ECMO, his chest radiograph had dramatica lly improved, his oxygen need had been reduced to 50%, and he was successfu lly weaned from ECMO. Two years later, he is doing extremely well. Therefor e, institution of ECMO using the femoral approach can be performed safely a t the bedside in the ICU, and can be lifesaving in the context of a very se vere reimplantation response after lung transplantation.