Bridge to Lung Transplant With Trans-septal Extra-corporeal Membrane Oxygenation (ECMO) for Right Heart Failure From Pulmonary Hypertension

Inclusion Criteria

Patients that are listed for lung transplantation and have:

• PH defined as:

• Group 1 Pulmonary arterial hypertension (PAH): Mean pulmonary artery pressure (PAP) ≥ 20 mm Hg, pulmonary capillary wedge pressure (PCWP) < 15 mm Hg, and pulmonary vascular resistance (PVR) ≥ 3 Wood units

• Group 3 PH is defined as the presence of chronic lung disease (CLD) and/or hypoxia and mean pulmonary artery pressure (PAP) ≥ 20 mm Hg.

• Secondary PH (WHO Group 3) or diagnosis of primary PH (WHO Group 1) (to include Eisenmenger syndrome).

• Failing right ventricle function defined as:

• a cardiac (CI) index < 2.2 L/min/m^2 despite continuous infusion of high dose inotropes defined as:

• Inhaled nitric oxide > 20 ppm and one of the following:

• Dobutamine > 10 ug/kg/min x 15 minutes or

• Milrinone > 0.5 ug/kg/min x 120 minutes or

• Epinephrine > 0.5 ug/kg/min x 15 minutes or

• Norepinephrine > 0.5 ug/kg/min x 15 minutes and have one of the following:

1. central venous pressure (CVP) > 15 mm Hg

2. global RV dysfunction on echocardiography defined as one of the following:

3. a tricuspid annular plane systolic excursion score of <14mm

4. an RV diameter at base >42mm

5. RV short-axis or midcavity diameter >35mm

• Lactate greater than 3 mmol/L

• Urine output < 0.5 ml/kg/hour

• Age > 18 years old

• BMI <35

• Informed consent signed by self or legally authorized representative.

Exclusion Criteria

• INTERMACS 1 patients (Critical cardiogenic shock patient who is "crashing and burning", has life-threatening hypotension and rapidly escalating inotropic or pressor support, with critical organ hypoperfusion often confirmed by worsening acidosis and lactate levels)

• End organ failure defined as: hepatic total bilirubin >5 mg/dL based on lab data within 24 hours prior to transseptal ECMO initiation; renal creatinine >4 mg/dLbased on lab data within the 24 hours prior to transseptal ECMO initiation

• Evidence of acute neurologic injury

• Active infection defined as two of the following WBC >12,500, positive blood culture, fever

• RA thrombus

• Thrombolysis within the previous 30 days or known existing coagulopathy such as thrombocytopenia or hemoglobin diseases such as sickle cell anemia or thalassemia

• Right heart failure from isolated pulmonary embolism

• Right heart failure from coronary artery disease or from left heart failure (WHO Type 2)

• Congenital forms of pulmonary hypertension such as tetralogy of fallot or pulmonary vein stenosis.