Extracorporeal membrane oxygenation & lung transplant outcomes: COVID-19 pandemic

The development of acute respiratory distress syndrome can be attributed to multiple causes, one of which was noted to be coronavirus disease 2019 (COVID-19). The syndrome leads to changes in the lungs, causing respiratory failure, which leads patients to become ventilator dependent. Interventions such as extracorporeal membrane oxygenation (ECMO) has improved outcomes in adult respiratory distress syndrome (ARDS) patients. However, it is not a permanent solution (1). Lung transplantation is indicated for patients with chronic obstructive pulmonary disease, interstitial lung disease, cystic fibrosis, emphysema secondary to alpha 1 antitrypsin deficiency, pulmonary arterial hypertension, bronchiectasis, pulmonary fibrosis, and sarcoidosis. During the COVID-19 pandemic, more patients with ARDS and fibrosis due to COVID-19 also underwent lung transplantation (2). However, long-term management with a lung transplant after a more prolonged ECMO course in a COVID-19 patient is a recent phenomenon that needs further studies to dictate patient selection criteria and long-term outcomes. In this editorial commentary, we comment on the article published by Hunt et al. in the recent issue of J Thorac Cardiovasc Surg (2). We evaluated their paper detailing ECMO as a bridging mechanism in patients who eventually underwent a lung transplant. The occurrence of lung transplants in cases of ARDS is rare but has recently increased during the COVID-19 pandemic where young patients who have developed ARDS and post-COVID-19 fibrosis have required ECMO and lung transplantation (2).