Lung transplantation in a patient with massive pneumomediastinum following 66 days of awake extracorporeal membrane oxygenation support: A case report

Kim, Jie Ae; Yang, Mikyung; Ahn, Hyun Joo; Lee, Eun Kyung; Choi, Jeong Yeon

Case Report

Cardiothoracic and Vascular Anesthesia

Anesthesia and Pain Medicine 2014;9(4):263-267.
Published online October 31, 2014.

Lung transplantation in a patient with massive pneumomediastinum following 66 days of awake extracorporeal membrane oxygenation support: A case report

Jie Ae Kim, Mikyung Yang, Hyun Joo Ahn, Eun Kyung Lee, Jeong Yeon Choi

Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. anes.yang@samsung.com

Received: 12 February 2014 • Revised: 10 March 2014 • Accepted: 16 April 2014

Abstract

In a 54-year-old man with interstitial lung disease associated with dermatomyositis, acute exacerbation of the disease had occurred and massive pneumothorax, pneumomediastinum and extensive subcutaneous emphysema were developed while waiting for lung transplantation. He was supported by awake extracorporeal membrane oxygenation (ECMO) for 66 days and bridged to lung transplantation, but mechanical ventilation was not done during ECMO period and induction period to avoid tension pneumothorax and cardiac tamponade. Notable points of this report are that the days of ECMO support were long, the type was awake ECMO, and positive pressure ventilation was not done during whole pretransplant period including anesthesia induction. The transplantation was done successfully and the patient was discharged 25 days after lung transplantation.

Key Words: Extracorporeal membrane oxygenation, Lung transplantation, Pneumomediastinum, Positive pressure ventilation