Extract
Acute decompensated pulmonary arterial hypertension (PAH) is characterized by rapid worsening of clinical signs of right heart failure (RHF) with subsequent congestion and systemic circulatory insufficiency that can lead to multisystem organ failure [1–3]. Short-term outcomes of acute decompensated RHF is very poor and remains the first cause of mortality in PAH [4, 5]. Intensive care of acute decompensated PAH is based on treatment of triggering factors, careful fluid management, and strategies to improve cardiac function and reduce right ventricular afterload [1]. However, this medical strategy is not always sufficient to restore a long-lasting balance between the afterload imposed on the right ventricle and its capacity for compensation. In case of refractory RHF despite maximal medical treatment, the use of mechanical support should now be considered in selected candidates for lung transplantation, or less commonly as a bridge to recovery in patients with a treatable cause of right-sided heart failure [1]. Veno-arterial extracorporeal membrane oxygenation (ECMO) is currently the most widely used strategy to support the right ventricle in PAH patients. This strategy, combined with changes in organ allocation rules to prioritize patients with a short-term life-threatening condition should contribute to improve survival of eligible patients with end-stage PAH [6]. However, long-term survival of patients admitted in ICU for severe acute RHF management has not been studied extensively in the modern management era of mechanical support and high-priority lung transplantation.
Footnotes
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Conflict of interest: Dr. Savale reports personal fees from Actelion, personal fees from Bayer, grants and personal fees from GSK, outside the submitted work; .
Conflict of interest: Dr. Vuillard has nothing to disclose.
Conflict of interest: Dr. Pichon has nothing to disclose.
Conflict of interest: Dr. Boucly has nothing to disclose.
Conflict of interest: Dr. Roche has nothing to disclose.
Conflict of interest: Dr. Jevnikar has nothing to disclose.
Conflict of interest: Dr. Ebstein has nothing to disclose.
Conflict of interest: Dr. Jais has nothing to disclose.
Conflict of interest: Dr. Le Pavec has nothing to disclose.
Conflict of interest: Pr. MONTANI reports grants and personal fees from Actelion, grants and personal fees from Bayer, personal fees from GSK, personal fees from Pfizer, grants, personal fees and non-financial support from MSD, personal fees from Chiesi, personal fees from Boerhinger, non-financial support from Acceleron, personal fees from Incyte Biosciences France, outside the submitted work.
Conflict of interest: Dr. Mercier has nothing to disclose.
Conflict of interest: Dr. SITBON reports grants, personal fees and non-financial support from Actelion Pharmaceuticals, grants and personal fees from Bayer HealthCare, grants and non-financial support from Merck, grants, personal fees and non-financial support from GlaxoSmithKline, personal fees from Arena Pharmaceuticals, outside the submitted work; .
Conflict of interest: Dr. Fadel has nothing to disclose.
Conflict of interest: Dr. Humbert reports personal fees from Acceleron, grants and personal fees from Actelion, grants and personal fees from Bayer, personal fees from GSK, personal fees from Merck, personal fees from Novartis, personal fees from Astrazeneca, personal fees from Sanofi, outside the submitted work.
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