Bridging via extracorporeal cardiopulmonary resuscitation for hemodynamic collapse in a patient with metastatic lung cancer: a case report.

BACKGROUND: Due to the highly invasive nature of veno-arterial extracorporeal membrane oxygenation (VA-ECMO), advanced malignancy is considered a relative contraindication. We here report a patient with hemodynamic collapse secondary to metastatic lung cancer in whom bridging via VA-ECMO was successful. CASE PRESENTATION: A 35-year-old man with metastatic non-small cell lung cancer harboring a deletion in exon 19 of epidermal growth factor receptor developed acute right ventricular failure and hemodynamic collapse due to pulmonary tumor thrombotic microangiopathy. Because treatment with the targeted agent osimertinib had already been initiated and a rapid response was anticipated, VA-ECMO was instituted as a bridge to its therapeutic effect. The patient's hemodynamics stabilized within 7 days, permitting VA-ECMO decannulation. At the time of writing, the patient is continuing to undergo regular outpatient follow-up. CONCLUSIONS: In carefully selected oncology patients with highly treatment-sensitive disease, short-term VA-ECMO may be an effective bridge to systemic therapy.