ECMO successfully served as a bridge to bilateral lung transplantation in a 31-year-old female with severe bleomycin-induced ARDS, leading to successful extubation and ongoing recovery.
Case Report (n=1)
ECMO and RVAD support can serve as a successful bridge to bilateral lung transplantation in patients with severe bleomycin-induced ARDS and right ventricular dysfunction.
Abstract Introduction Bleomycin-induced lung injury (BILI) is an uncommon but serious complication of chemotherapy, capable of progressing rapidly to acute respiratory distress syndrome (ARDS). Severe cases may require extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation. We present a case of a young adult with BILI complicated by refractory ARDS, right ventricular dysfunction, and perioperative bleeding, ultimately surviving with bilateral lung transplant. Case Presentation A 31-year-old female with stage III ovarian teratoma, status post right salpingo-oopherectomy, subsequently started on BEP (bleomycin, etoposide, and cisplatin) chemotherapy on cycle 3 out of 4 (last 8/11/25), presented with acute hypoxic respiratory failure on 8/21/25. She progressed to ARDS requiring mechanical ventilation, proning, and paralysis. VV ECMO was initiated on 9/10/25 for refractory hypoxemia. ECMO management was complicated by cannula chugging, high sedation requirements, and impaired neurologic assessment. Echocardiography revealed a tricuspid sub-chordal echodensity and right ventricular dysfunction, prompting transition to Protek Duo RVAD on 9/30/25. The hospital course was further complicated by bleeding from tracheostomy and pericardial effusion requiring thoracotomy and pericardial window. After multidisciplinary optimization, the patient underwent VA ECMO-assisted bilateral lung transplant (BOLT) on 10/21/25. Postoperatively, she was successfully extubated, engaged in intensive rehabilitation, and continues recovery with ongoing physiotherapy. She is currently under surveillance for her cancer with no evidence of disease on imaging. Discussion BILI can result in life-threatening ARDS requiring advanced support. This case highlights the role of ECMO as a bridge to lung transplantation, the challenges of right ventricular dysfunction, anticoagulation management, and perioperative bleeding. Its demonstrates the importance of early recognition of chemotherapy-induced lung toxicity and coordinated care. Learning Point Clinicians should maintain high suspicion for bleomycin-induced lung injury in patients with new respiratory failure after chemotherapy. Timely escalation to ECMO and transplant evaluation can be lifesaving in select patients.AI-assisted language editing was used; all case details and interpretation were authored by the authors. This abstract is funded by: None
Lanka et al. (2026) conducted a case report in Bleomycin-induced lung injury (BILI) with ARDS (n=1). ECMO and bilateral lung transplant was evaluated. ECMO successfully served as a bridge to bilateral lung transplantation in a 31-year-old female with severe bleomycin-induced ARDS, leading to successful extubation and ongoing recovery.