{'fraction_non_alphanumeric': 0.02702702702702703, 'fraction_numerical': 0.01583011583011583, 'mean_word_length': 5.5761421319796955, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
186: SEVERE RESPIRATORY FAILURE POST-TOTAL ARTIFICIAL HEART IMPLANTATION

with biventricular failure and multiple-systemic organ compromise. The development of post-implantation acute respiratory failure with profound hypoxic lung injury has previously been reported. Veno-venous (VV) as well as VA ECMO has been successfully used in case studies as a suitable strategy to enable adequate oxygenation whilst allowing time for recovery of lung function. We have reviewed our experience. Methods: Single-centre, case series review of patients who required VV ECMO in conjunction with the TAH (Syncardia, USA). Results: The underlying etiology of cardiac dysfunction included: dilated cardiomyopathy; myocarditis; biventricular failure postvalvular surgical intervention, and biventricular failure following ascending aortic dissection repair. 4 patients were bridged to TAH on VA ECMO, with average treatment duration of 6 days; all these patients were intubated. Prior to ECMO cannulation, the average FiO2:PaO2 ratio was 56 (49–73.9) associated with a significant deterioration in respiratory mechanics with increased plateau inspiratory pressures (28-36cmH2O), and reduction in tidal volumes (217-400cc) and lung compliance. All of the patients had bilateral pulmonary infiltrates on chest radiographs. In four patients VV ECMO support was initiated prior to leaving theatre and in the other after 11 hours on ITU. In all cases the indication was refractory and severe hypoxemia. One patient had a Protek Duo cannula (Cardiac Assist, Pittsburgh, PA, USA), the others had two-cannula configurations. ECMO support was weaned off successfully in 4 patients after significant improvement in respiratory function, with an average treatment duration of 152h. One patient developed multi-organ failure and both TAH and VV ECMO support was withdrawn. Conclusions: The mechanism of this acute lung injury would appear to have multiple contributing factors including pre-existing lung injury, pulmonary edema secondary to mechanical obstruction of venous return during chest closure, and reperfusion lung injury. Additionally, pre-implantation VA ECMO support may mask pre-existing lung pathology. There were no additional operative factors or prolonged cardiopulmonary bypass times that may suggest a reason for deterioration in lung function. We describe our experience after TAH implantation and how VV ECMO was successfully weaned off in 4 out of 5 patient with resolution of the acute lung pathology. CCMCritical Care MedicineCrit Care Med0090-3493Lippincott Williams & WilkinsHagerstown, MDCCM