A102-16 Transvenous Diaphragmatic Neurostimulation to Facilitate Ventilator Weaning in Post-lung Transplant Patients

Abstract Rationale Prolonged mechanical ventilation (MV) occurs in approximately 14% of post lung transplant patients and is associated with increased mortality. The AeroPace temporary transvenous diaphragmatic neurostimulation (TTDN), a novel FDA-approved device, has been shown to shorten MV duration by an average of 2.8 days (Lungpacer Medical, PA). In the RESCUE3 study, the AeroPace patient were weaned 34% faster by day 30 or 43% faster per protocol. We describe our single-center experience using TTDN in lung transplant recipients requiring prolonged MV and extracorporeal membrane oxygenation (ECMO). Methods Between June and August 2021, patients with difficulty weaning from MV following lung transplantation at the University of Florida were identified under the Emergency Use Authorization (EUA) program during the COVID-19 pandemic. The AeroPace TTDN subclavian catheter was placed at bedside. Each TTDN session delivered 60 electrical stimulations, administered once or twice daily during volume-controlled or pressure-support ventilation. Therapy was continued until successful liberation from MV or for a maximum of 30 days. Results Three patients underwent TTDN therapy. Case 1: A 55-year-old man underwent bilateral orthotopic lung transplantation (BOLT) for drug-induced fibrotic lung disease, complicated by primary graft dysfunction requiring veno-venous (VV) ECMO and six months of MV. After 30 days of TTDN and subsequent automatic tube compensation (ATC) trials, he was successfully liberated from MV. Case 2: A 48-year-old woman received BOLT for COVID-19-related respiratory failure complicated by multiple episodes of hospital-acquired pneumonia. TTDN was initiated one month post-transplant, leading to successful liberation after six sessions. Case 3: A 55-year-old man underwent lung-kidney transplantation for COVID-19-associated respiratory failure requiring VV ECMO. TTDN was started two weeks post-transplant, while still on ECMO. Patient was weaned from MV after nine days of therapy. All patients tolerated TTDN without complications related to catheter placement or stimulation. Conclusion This case series is the first to report the use of TTDN in post-lung transplant patients with prolonged MV. TTDN was well tolerated and may facilitate earlier ventilator liberation by mitigating diaphragmatic atrophy associated with prolonged MV. Further prospective studies are warranted to evaluate its efficacy in improving post-transplant outcomes. This abstract is funded by: None