Venovenous Extracorporeal Membrane Oxygenation After Lung Transplant: A Case Report

Introduction Extracorporeal membrane oxygenation is an invasive form of mechanical therapy for patients requiring circulatory or respiratory support. Venovenous extracorporeal membrane oxygenation supports patients’ lungs by oxygenating the blood, replacing pulmonary gas exchange function, and allowing a failing lung to recover. This supportive therapy can be used to treat patients with acute rejection following a lung transplant. Clinical Findings A 59-year-old White man was admitted for bilateral orthotopic lung transplant and was nearing the time of discharge home after the procedure. However, acute decompensation on postoperative day 17 prolonged the patient’s hospitalization. Diagnosis The patient received a diagnosis of antibody-mediated rejection. Intervention The patient completed antibody-mediated rejection treatment and underwent cannulation for venovenous extracorporeal membrane oxygenation. The extracorporeal membrane oxygenation cannulation was later changed to a venovenous-venous configuration to manage ongoing hypoxemia. Outcomes Postoperative complications related to the diagnosis of acute rejection resulted in prolonged hospitalization. The patient was transferred out of the intensive care unit on postoperative day 93. He was discharged home when he was hemodynamically stable. Conclusion Acute rejection occurs in nearly one-third of patients after lung transplant, highlighting the need for accurate patient diagnosis. This case report discusses the treatment of antibody-mediated rejection, demonstrates how venovenous extracorporeal membrane oxygenation can be used to support a patient with acute rejection following a lung transplant, and highlights the crucial role of critical care nurses in treating patients receiving extracorporeal membrane oxygenation.