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Timeline.. CPR: cardiopulmonary resuscitation; EKG: electrocardiogram; rTPA = recombinant tissue plasminogen activator; EVLP = Ex-vivo lung perfusion; min = minutes; VA ECMO = veno-arterial extracorporeal membrane oxygenation.
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Cardiopulmonary resuscitation (CPR) was started 5 min after the collapse (see the process timeline in Fig. 1); the donor had been brought to a peripheral hospital, located 118 km away from our centre and with no extracorporeal life support program.
Donor chest X-ray.
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Chest x-ray was clear (Fig. 2), but the bronchoscopic evaluation confirmed the signs of pool water inhalation and copious frothy secretions.
A: Lungs appearance during EVLP; B: Lungs X-ray after EVLP.
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After 255 min of normothermic perfusion, grafts were judged suitable for transplantation according to the usual parameters (Fig. 3).
Recipient CT-scan before transplantation.
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The recipient was a 26-year old female with cystic fibrosis who had chronic colonization from Pseudomonas aeruginosa and allergic bronchopulmonary aspergillosis (ABPA) (Fig. 4).
Recipient CT-scan 2 years after lung transplantation.
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The patient is alive and well two years after transplantation (FEV1 = 69%, last room air 6-minutes-walking-test = 590 m, bronchoscopy: no signs of acute rejection nor anastomotic complications), she has a good quality of life and is leading an extremely active life (Fig. 5).