J Korean Med Sci.  2021 May;36(17):e123. 10.3346/jkms.2021.36.e123.

Experience of International Air Transportation and Subsequent Lung Transplant in a Patient with COVID-19-associated Acute Respiratory Distress Syndrome: a Case Report

Affiliations
  • 1Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 2Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 3Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Abstract

We report an inspiring case of a 55-year-old Korean female diagnosed with coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS) in Mexico. The patient was assessed for lung transplant as a salvage therapy for treatment-refractory ARDS following no signs of clinical improvement for > 7 weeks, despite best treatment.The patient was transported from Mexico to Korea by air ambulance under venovenous extracorporeal membrane oxygenation (ECMO) support. She was successfully bridged to lung transplant on day 88, 49 days after the initiation of ECMO support. ECMO was successfully weaned at the end of operation, and no bleeding or primary graft dysfunction was observed within the first 72 hours. The patient was liberated from mechanical ventilation on postoperative day 9 and transferred to the general ward 5 days later. Despite the high doses of immunosuppressants, there was no evidence of viral reactivation after transplant.At 3 months post-transplantation, she was discharged to home without complication. Our experience suggests that successful lung transplant for COVID-19-associated ARDS is feasible even in a patient with prolonged pre-transplant ECMO support. Lung transplant may be considered a salvage therapy for COVID-19-associated ARDS that does not respond to conventional treatments.

Keyword

Acute respiratory distress syndrome; COVID-19; Extracorporeal membrane oxygenation; Lung transplantation; Rehabilitation

Figure

  • Fig. 1 Timeline of the patient's clinical course.Note that prolonged pre-transplant mechanical ventilation for 84 days and V-V ECMO for 49 days.ICU = intensive care unit, V-V ECMO = venovenous extracorporeal membrane oxygenation.

  • Fig. 2 Radiological images and pathological finding of the lungs.(A) Chest X-rays of the patient on day 87, a day before lung transplantation and (B) on day 175 (postoperative day 87), a day before hospital discharge. (C) Chest computed tomography scan on day 70 and (D) on day 113 (postoperative day 25). (E) Microscopic image of hematoxylin and eosin staining of explanted lung.


Reference

1. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020; 8(5):475–481. PMID: 32105632.
Article
2. Chang Y, Lee SO, Shim TS, Choi SH, Kim HR, Kim YH, et al. Lung transplantation as a therapeutic option in acute respiratory distress syndrome. Transplantation. 2018; 102(5):829–837. PMID: 29189633.
Article
3. Yun JH, Lee SO, Jo KW, Choi SH, Lee J, Chae EJ, et al. Infections after lung transplantation: time of occurrence, sites, and microbiologic etiologies. Korean J Intern Med. 2015; 30(4):506–514. PMID: 26161017.
Article
4. Yao H, Samoukovic G, Farias E, Cimone S, Churchill-Smith M, Jayaraman D. Safety and flight considerations for mechanical circulatory support devices during air medical transport and evacuation: a systematic narrative review of the literature. Air Med J. 2019; 38(2):106–114. PMID: 30898281.
Article
5. Falcoz PE, Monnier A, Puyraveau M, Perrier S, Ludes PO, Olland A, et al. Extracorporeal membrane oxygenation for critically ill patients with COVID-19-related acute respiratory distress syndrome: worth the effort? Am J Respir Crit Care Med. 2020; 202(3):460–463. PMID: 32543208.
Article
6. Cypel M, Keshavjee S. When to consider lung transplantation for COVID-19. Lancet Respir Med. 2020; 8(10):944–946. PMID: 32857989.
Article
7. Lang C, Jaksch P, Hoda MA, Lang G, Staudinger T, Tschernko E, et al. Lung transplantation for COVID-19-associated acute respiratory distress syndrome in a PCR-positive patient. Lancet Respir Med. 2020; 8(10):1057–1060. PMID: 32857987.
Article
8. Han W, Zhu M, Chen J, Zhang J, Zhu S, Li T, et al. Lung transplantation for elderly patients with end-stage COVID-19 pneumonia. Ann Surg. 2020; 272(1):e33–e34. PMID: 32301803.
Article
9. Crotti S, Iotti GA, Lissoni A, Belliato M, Zanierato M, Chierichetti M, et al. Organ allocation waiting time during extracorporeal bridge to lung transplant affects outcomes. Chest. 2013; 144(3):1018–1025. PMID: 23599162.
Article
10. Tipograf Y, Salna M, Minko E, Grogan EL, Agerstrand C, Sonett J, et al. Outcomes of extracorporeal membrane oxygenation as a bridge to lung transplantation. Ann Thorac Surg. 2019; 107(5):1456–1463. PMID: 30790550.
Article
11. RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med. 2021; 384(8):693–704. PMID: 32678530.
Article
12. Yang JW, Yang L, Luo RG, Xu JF. Corticosteroid administration for viral pneumonia: COVID-19 and beyond. Clin Microbiol Infect. 2020; 26(9):1171–1177. PMID: 32603802.
Article
13. He X, Lau EH, Wu P, Deng X, Wang J, Hao X, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. 2020; 26(5):672–675. PMID: 32296168.
Article
Full Text Links
  • JKMS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr