Lung-less Patient on VA ECMO waiting for Pericardial reconstructed Lung Left Atrium

An on-pump veno-arterial (VA) ECMO strategy allows safe stabilization and preparation of a lung-less patient while awaiting immediate implantation of the recipient graft. Following bilateral pneumonectomy, VA ECMO provides full cardiopulmonary support, maintaining systemic perfusion and oxygen delivery while unloading the right ventricle and preventing hemodynamic collapse. This approach enables meticulous hemostasis, controlled mediastinal conditions, and precise preparation of the pulmonary hilum and atrial cuffs, optimizing the surgical field for implantation. Continuous ECMO support also preserves end-organ function, maintains acid–base balance, and allows seamless transition to graft reperfusion once the donor lungs are ready, thereby improving procedural safety and recipient readiness during complex or high-risk lung transplantation.

Dr.Sam Zeraatian Nejad Davani, Cardiovascular and Transplant surgeon. Advanced Fellow of Thoracic Organs Transplantation Chicago Illinois.