Maximizing cardiopulmonary support as a minimally invasive platform-using peripheral parallel veno-venous and veno-arterial extracorporeal membrane oxygenation and axillary impella 5.5 as a bridge to heart-lung transplantation.

Combined heart-lung transplantation (HLTx) in patients with cardiopulmonary failure requiring extracorporeal membrane oxygenation (ECMO) presents a major physiologic challenge. Conventional ECMO strategies may inadequately address simultaneous refractory hypoxemia, circulatory failure, and left ventricular (LV) distension without central cannulation and sternotomy. A 65-year-old man with severe heart failure (LVEF <10%) and rapidly progressive interstitial lung disease presented with cardiogenic shock and hypercapnic hypoxemic respiratory failure. Initial V-AV ECMO provided stabilization and allowed extubation and expedited HLTx evaluation. Progressive hypoxemia and acute kidney injury despite maximal V-AV support prompted escalation to peripheral parallel VV-VA ECMO. Echocardiography demonstrated LV distension, prompting axillary Impella 5.5 placement for decompression. The patient remained awake and extubated on parallel VV-VA ECMO and Impella 5.5 for 60 hours prior to successful heart-lung transplantation. We report the novel application of a fully peripheral cardiopulmonary support platform as a viable bridge strategy for HLTx candidates.