Feasibility of transbronchial lung cryobiopsy in patients with veno-venous extracorporeal membrane oxygenation support

BackgroundVeno-venous extracorporeal membrane oxygenation (VV-ECMO) is essential life support in patients with severe acute hypoxemic respiratory failure. However, biopsies should be considered for some patients with unknown etiology. This study aims to evaluate the feasibility of transbronchial lung cryobiopsy (TBLC) in such patients.MethodsAll patients with acute hypoxemic respiratory failure of unknown etiology who underwent TBLC with VV-ECMO support were retrospectively reviewed. Patients’ characteristics, ventilation settings, procedure parameters, complications, pathological diagnosis, and survival were summarised and analysed.ResultsEight female and five male patients with VV-ECMO support underwent TBLC. The median age was 58 (IQR 38–67) years old. Concurrent diseases were present in 10 of the 13 patients, seven of which were immunosuppressed. The median time between biopsy and VV-ECMO establishment was 2.0 (IQR 0.5–6.5) days. No patient died from the procedure. Neither pneumothorax nor severe bleeding occurred in any of the patients. Five of the 13 patients experienced moderate bleeding, and all bleeding events were successfully controlled with prophylactic balloon blockers. Pathological diagnosis by TBLC was obtained in all patients. And the diagnosis of diffuse alveolar damage (DAD) was made in nine of them.ConclusionsIn patients with VV-ECMO support, the TBLC procedure is generally safe when standardised bleeding prophylaxis is in place. TBLC is contributive to identifying underlying etiologies in patients with acute hypoxemic respiratory failure of unknown etiology.