A case series of ecmo use for advanced pulmonary procedures

SESSION TITLE: Novel Pleural and Bronchoscopic Techniques SESSION TYPE: Case Reports PRESENTED ON: 10/11/2023 08:30 am - 09:30 am INTRODUCTION: We present a case series supporting the use of short term Venovenous Extracorporeal Membrane Oxygenation (VV-ECMO) in patients with acute hypoxic respiratory failure requiring advanced bronchoscopic procedures. CASE PRESENTATION: 44-year-old male who was hospitalized for pharyngeal abscess with airway compromise and necrotizing MRSA pneumonia. Hospital course was complicated by worsening acute hypoxic respiratory failure due to right pneumothorax with persistent air leak and hemodynamic instability. He was placed on VV-ECMO to safely place endobronchial valves (EBV). Three EBV's were placed in the right upper lobe with complete resolution of persistent air leak. Patient improved post procedure and was weaned off ECMO support. 61-year-old female with acute hypoxic respiratory failure secondary to pulmonary alveolar proteinosis who was admitted for whole lung lavage (WLL). The patient successfully underwent right WLL. When left WLL was attempted she became hemodynamically unstable, and procedure was aborted. The patient was placed on VV-ECMO to safely reattempt left WLL. Following ECMO cannulation she successfully underwent left WLL with improvement in compliance and oxygenation post procedure. The patient was decannulated from ECMO 3 days post procedure and liberated from mechanical ventilation.72-year-old female with history of COPD who was admitted for acute hypoxic respiratory failure secondary to right pneumothorax requiring mechanical ventilation. At presentation a chest tube was placed with re-expansion of the right lung. Chest tube was removed inadvertently, and the patient developed subcutaneous emphysema and reoccurrence of the pneumothorax. After right chest tube was replaced patient became hemodynamically unstable and noted to have a left sided tension pneumothorax. Left chest tube was placed, and subsequently had right persistent air leak. She was deemed a candidate for EBV placement, but would require VV-ECMO for procedural support. Two EBV's were placed in RUL and one in RLL with improvement in right sided air leak. She was weaned off from ECMO post procedure DISCUSSION: Patients requiring advanced bronchoscopic procedures can pose difficult obstacles in procedural planning due to the acuity of their clinical presentation related to their underlying pulmonary pathology. Published case reports have supported the use of short term VV-ECMO to provide patients with oxygenation and ventilation during advanced airway procedures. These are in the setting of central airway obstruction secondary to tracheal stenosis, malignancy and hemoptysis. Short term VV-ECMO was successfully used to provide procedural support with limited associated morbidity. CONCLUSIONS: This case series shows the use of short term VV-ECMO in patients with acute hypoxic respiratory failure requiring advanced bronchoscopic procedures for treatment, is an option for patients who otherwise would not have been able to safely undergo bronchoscopy. REFERENCE #1: Natt B, Knepler J Jr, Kazui T, Mosier JM. The Use of Extracorporeal Membrane Oxygenation in the Bronchoscopic Management of Critical Upper Airway Obstruction. J Bronchology Interv Pulmonol. 2017 Jan;24(1):e12-e14. doi: 10.1097/LBR.0000000000000347. PMID: 27984394. REFERENCE #2: Malpas G, Hung O, Gilchrist A, Wong C, Kent B, Hirsch GM, Hart RD. The use of extracorporeal membrane oxygenation in the anticipated difficult airway: a case report and systematic review. Can J Anaesth. 2018 Jun;65(6):685-697. English. doi: 10.1007/s12630-018-1099-x. Epub 2018 Mar 1. PMID: 29497994. REFERENCE #3: Lin J, Frye L. The intersection of bronchoscopy and extracorporeal membrane oxygenation. J Thorac Dis. 2021 Aug;13(8):5176-5182. doi: 10.21037/jtd-2019-ipicu-08. PMID: 34527357; PMCID: PMC8411169. DISCLOSURES: No relevant relationships by David Chambers No relevant relationships by Robert Holladay No relevant relationships by Andrea Ramirez No relevant relationships by Najam Siddiqui No relevant relationships by Angel Yazdi