Respiratory failure is a common cause of death. It is proven that Extracorporeal Membrane Oxygenation (ECMO) cannulation is successful in bridging patients to lung transplantation. Here we report on a 51-year-old patient with COPD who was bridged successfully to lung transplantation using venous-venous ECMO with a Protek Duo RD™ dual lumen cannula; which contributed to our success in bridging to transplant without the need for anticoagulation. Here we confirm that the clinical application use of the cannula without IV Heparin use is safe and feasible.

Cardiac Transplantation as Surgical Treatment for Cardiac Sarcoidosis Ali Ghodsizad MD, PhD, FACC, FETCS, FACSSarcoidosis is a complex disease with different clinical presentations that can involve multiple organs (1). The lung is typically the most common organ involved, multiple organ involvements with pulmonary and cardiac sarcoidosis account for most of the morbidity and mortality observed with this disease (1). Cardiac sarcoidosis presents as a progressive infiltrative cardiomyopathy that can lead to heart failure, arrhythmia and death (1).Here McGoldrick and colleagues report on their database study with data from Organ Procurement and Transplantation Network (OPTN) involving 289 cardiac sarcoidosis patients with end stage restrictive cardiomyopathy, who needed cardiac transplantation and compared them with all non-sarcoid patients undergoing cardiac transplantation for restrictive cardiomyopathy and end stage heart failure of other causes between Jan 1999 to March 2020 (n=41447).Patients with cardiac sarcoidosis had a comparable survival to non-sarcoid patients at 1 and 5 years and a significantly longer survival at up to 10 years.Patients with cardiac sarcoidosis had an increased chance to die from aspergillus infections at 1 year. Jackson et al showed in their multicenter trial comparable survival, rate of graft failure, and incidence of treated rejection at 1 year when compared to matched non-sarcoid patients. Sarcoid patients after heart transplantation were less likely to be hospitalized for infection in their study at 1 year (2). Liu et al performed a similar UNOS data base study showing that cardiac sarcoidosis heart transplant recipients were an older population with less underlying co-morbidities with a lower overall mortality (3).The diagnosis of cardiac sarcoidosis in patients who undergo left ventricular assist device implantation can be confirmed by histological examination of myocardium at the time of ventricular assist device insertion, but unclear is the predictive value (4,5).McGoldrick and colleagues excluded patients who required multiorgan transplantation in all 3 groups and we have to consider that multiorgan recipients belong to the sickest subpopulation.McGoldrick et al and other groups confirm the role of cardiac transplantation as a viable option for patients with cardiac sarcoidosis. Considering the increasing number of the cardiac transplantation for sarcoidosis in recent years, the 10 years survival data may have to be reevaluated with more follow up time in future.

Cytokine Filter Application in COVID-19 Patients; Island of Hope for Crash and Burn Patients or Future Solution for All Septic Acute Respiratory Distress Syndrome (ARDS) PatientsAli Ghodsizad MD, PhD, FACC, FETCS, FACSThe COVID-19 pandemic crisis certainly has challenged the scientific community as well as entire world. While incidence numbers have decreased following expedited vaccination and precautions, still some patients present with COVID 19 related pneumonia and ARDS requiring Veno-Venous Extracorporeal Membrane Oxygenation (VV ECMO) support to survive.In COVID-19 patients a cytokine release syndrome concomitant with ARDS can lead to overwhelming clinical scenario. Geraci and colleagues report on their single center feasibility study looking at application of the CytosorbTM hemadsorption device which was used as a parallel circuit within the VV ECMO circuit.The authors give evidence for safety and feasibility of the CytosorbTM hemadsorption device use in 10 patients with COVID-19 related ARDS in combination with VV ECMO. They show a reduction of inflammatory markers and cytokines following hemadsorption treatment. The cytokine storm can cause a critical clinical picture of septic shock. Only under high vasopressor and inotropic support end organ perfusion can be maintained. The required invasive pressure ventilation with high PEEP and peak pressure can decrease the intrathoracic venous return further and contributes more to the shock physiology (1). We have to look at inspiring results from current single center experience carefully understanding the evolving nature of COVID-19 related ARDS. Other groups have used plasmapheresis and CVVH modifications in COVID-19 cases. Dominik et al have shown a significant benefit only using hemadsorption comparing to other used protocols (2).We have shown successful application of somatic stem cells in COVID-19 patients on VV ECMO at our center. We could observe a reduction of inflammatory markers following somatic stem cell application (3). COVID 19 ARDS patients who required VV ECMO support, underwent a Pulmonary Artery (PA)-catheter placement and allogenic human stem cell injection into the PA using the PA-catheter as part of our expanded access protocol (3,4).Brouwer and colleagues, another group working with hemadsorption, have actually shown reduced survival in patients undergoing hemadsorption therapy (5). Geraci and colleagues describe their overall VV ECMO survival for COVID 19 related respiratory failure to be > 90%. Others including our center have experienced a much lower survival in that patient population. So patient selection clearly is a key point. The results presented by Geraci and colleagues have to be taken as a pioneering step, which can help in ARDS and septic clinical scenarios with different pathology in future.