Longer duration of extracorporeal membrane oxygenator support, low pH and urine output in the first 24 hours, and renal failure are significant factors associated with mortality during extracorporeal membrane oxygenator support. Exposure to high amounts of blood transfusion during extracorporeal oxygenation, extended extracorporeal membrane oxygenator support, and sepsis increase risk of death after successful decannulation.

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Key Clinical MessageThis case report describes a patient with a 22q11.2 duplication. His features, which include VACTERL association with an esophageal atresia/tracheo‐esophageal fistula and a vascular ring, expand the previously described phenotype for this duplication.

Bhattacharyya and colleagues 4 reported a case of decompression of an emphysematous bulla through a transbronchial aspiration needle. We considered this strategy to be unsuitable for our case because of the high risk of pneumothorax or bronchopleural fistula.Finally, we considered using EBVs, which were designed for the treatment of emphysema and have been applied successfully for occlusion of bronchopleural 1 and bronchocutaneous 5 fistulas. The EBVs work like a Heimlich valve, allowing escape of air and secretions from bulla at expiration (Figure 2, B) but preventing air inflow at inspiration (Figure 2, C), thus resulting in a redirection of airflow away from the blocked segments. The result is deflation of the GEB and the re-expansion of the more normal adjacent lung.Our experience confirms that this noninvasive bronchoscopic treatment may represent a valuable alternative for patients who are poor surgical candidates. Bronchoscopic EBV insertion is easily placed by a thoracic surgeon familiar with interventional endoscopic procedures, well tolerated, and easily removed if necessary. Large series and longterm trials are needed for adequate validation of the technique described.

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