Bilateral pneumonectomies and ECMO support

I read with fascination these case reports about bilateral pneumonectomies with ECMO support – came up during Lung Rescue discussion.

From Cypel et al

https://www.sciencedirect.com/science/article/pii/S0022522316316233 – Cypel et al, a CF patient who had shock from Pseudomonas bacteremia who had this done to get source control, after pneumonectomies, she had dramatic improvement. Had this configuration:

https://www.sciencedirect.com/science/article/pii/S1053249819316298?via%3Dihub – Barac et al, another young CF patient with Bulkholderia, with bilateral pneumonectomies to clear his infection prior to transplant. With this layout:

Really interesting to read about these cases. A more recent case: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8780122/ – severe COVID respiratory failure on ECMO with persistent COVID and Stenotrophomonas, interestingly had a PFO that was used for shunting to offload the left ventricle (they suggest atrial septostomy could be performed in those who don’t have a PFO).