Massive hemoptysis successfully treated with extracorporeal membrane oxygenation and endobronchial thrombolysis

Abstract

Extracorporeal membrane oxygenation has been used to treat refractory hypoxemia in numerous clinical scenarios. The fundamental principles for the management of massive hemoptysis patients include protecting the airway and healthy lung, locating the source of bleeding and controlling the hemorrhage. We report the case of a patient with acute respiratory failure associated with massive hemoptysis secondary to lung laceration during cardiac surgery. The use of extracorporeal membrane oxygenation allowed patient survival. However, due to the great difficulty in managing pulmonary clots after hemoptysis, it was necessary to use an unusual therapy involving endobronchial infusion of a thrombolytic agent as described in rare cases in the literature.

Extracorporeal Life Support in Hemorrhagic Conditions: A Systematic Review

“…Through the literature search, 614 articles were found in Pubmed, 488 in Medline, 869 in Embase, and 5 by searching the references in publications included in the analysis (Figure 1). The following subgroups were created based on the bleeding conditions: 1 patient with tracheal injury, 13 11 patients with postpartum or cesarean delivery hemorrhage, 14–19 7 patients with intracranial hemorrhage, 20–25 53 patients with pulmonary hemorrhage, 5,26–66 13 patients with postpulmonary endarterectomy bleeding, 67–72 and 96 patients with bleeding trauma 51,73–96 (Table 1; see Supplementary Tables 1–5, Supplemental Digital Content, http://links.lww.com/ASAIO/A515). Overall, 183 patients were identified in 86 included publications, namely, 74 case reports, 4 case series, 7 retrospective database observational studies, and 1 preliminary results of ongoing study.…”

“…The heparin-free period varied between 4 hours and 2 days in 12 patients. 5,22,33,39,51,65,75,84 Re-start of anticoagulation was performed after damage control surgery, detection of clots in the circuit, or control of the bleeding site. 23,26,41,46,53,56,74,84,94,96 In seven patients, the heparin-free time was not specified 15,71,91 (Supplemental Figure 2, Supplemental Digital Content, http://links.lww.com/ASAIO/A515).…”