A Case of Massive Airway Clotting After Use of Activated Factor VII for Massive Hemoptysis

Abstract

This case describes the use of flexible bronchoscopy and cryoadhesion in an 83-year-old man who developed large airway clots following treatment with activated factor VII for a complication of pulmonary hemorrhage during coronary artery bypass graft.

Blood clot removal by cryoextraction in critically ill patients with pulmonary hemorrhage

“…The success rate of 93% is high and corresponds well to other published data (14)(15)(16)(17)(18)(19)(20). Of interest, no relevant difference with regard to univariate overall survival was observed between patients, who depended on ECMO and patients without ECMO treatment.…”

“…Our study collective contains patients of all ages between 29 and 77 years, similar to other published studies (14)(15)(16)(17)(18)(19)(20). All identified patients depended on mechanical ventilation.…”

“…Freezing the blood clots facilitates removal. Successful cryoextraction has been reported in several case reports (Table 1) (14)(15)(16)(17)(18)(19)(20). For tumor ablation in symptomatic patients with malignant endobronchial or tracheal tumors the use of cryo-probes is already recommended (21).…”

Bronchoscopic Interventions in Patients With Hemoptysis

“…Bronkoskopun çalışma kanalından girilerek kanama odağının soğuk serum fizyolojikle veya adrenalinli serum fizyolojikle yıkanması, kanama odağına balon tamponatı uygulanması, stent veya silikon tıkaç ile tamponat uygulaması, kanama odağının elektrokoter, lazer, argon plazma veya kriyoterapi yön-temlerinden biriyle koagüle edilmesi gibi yöntemlerle bronkoskopik hemoptizi tedavisi mümkündür (2,(11)(12)(13)(14).…”

Foreign body removal is getting “cooler”

“…Those who have utilized cryoadhesion cite specific advantages of the cryoprobe compared to traditional forceps depending on circumstances. For example, aspirated foods that can sometimes fragment under the pressure of forceps can be removed whole using the cryoprobe, while other lesions, such as blood clots or inflammatory casts, which are extremely difficult to grasp (ie “slippery”) using traditional forceps, can be successfully and more rapidly removed by freezing the proximal portion onto the tip of the probe . For select non‐organic foreign bodies that may not adhere sufficiently to the probe (ie metal or plastic), some have instilled a small aliquot of saline onto or around the object prior to initiating the freezing process.…”