Bronchoscopy-guided intervention therapy with extracorporeal membrane oxygenation support for advanced cancer metastasis to the central airway

Abstract

Introduction: Dyspnea due to tracheal invasion by malignant tumors is a common oncological emergency that is difficult to manage, and a common cause of death among patients with advanced cancer. Bronchoscopy-guided intervention therapy under conventional ventilation is very risky for patients with severe central airway stenosis. Extracorporeal membrane oxygenation (ECMO) provides strong cardiopulmonary support, but is rarely used in bronchoscopy-guided interventional therapy. Patient concerns: The patient had advanced esophageal cancer with metastases to the trachea and left and right main bronchi. Despite several sessions of radiotherapy, chemotherapy, and bronchoscopy-guided intervention therapy, the tumor in the airway became enlarged, the lumen was severely narrow, and the patient experienced respiratory distress. Diagnosis: A thoracic computed tomography scan performed at our hospital revealed invasion of the trachea and opening of the left and right main bronchi by the esophageal cancer, blockage of the stent by the tumor, and severe luminal narrowing. An emergency bronchoscopy showed slit-like stenosis of the middle and lower part of the trachea and the left and right main bronchi, and the tumor was highly vascular. Interventions: To reduce the risk of major airway bleeding and asphyxia during bronchoscopy under conventional ventilation, we finally performed argon plasma coagulation with a high frequency electric knife and cryotherapy with ECMO support. Outcomes: We successfully cleared the tumor tissue in the airway under ECMO support. The trachea and left and right main bronchi recovered smoothly, and the patient was soon discharged. Conclusion: ECMO can meet the oxygenation needs during bronchoscopy-guided intervention therapy. For patients with severe central airway obstruction due to malignant tumors, ECMO should be considered if conventional respiratory support cannot guarantee the safety of surgery.

Successful application of extracorporeal membrane oxygenation treatment in the management of severe respiratory failure caused by primary pulmonary lymphoma

“…ECMO has recently been used to treat acute cardiopulmonary failure in patients with malignant tumors. [6][7][8] Cancer frequently experience serious complications from malignancy or treatment. Kenneth et al examined the ELSO Registry database for adults with malignancies from 1992 to 2008.…”

Bronchoscopy-Guided Intervention Therapy With Extracorporeal Membrane Oxygenation Support for Relapsing Polychondritis With Severe Tracheobronchomalacia: A Case Report and Literature Review

“…ECMO is also called extracorporeal life support. Its main purpose is to provide blood oxygenation, remove carbon dioxide, and ensure effective blood supply to the body; hence, by providing emergency and critically ill patients with respiratory and circulatory support, thereby playing an important role in emergency and critical care ( 4 ). The treatment modes of ECMO mainly include VV-ECMO and venous-arterial ECMO (VA-ECMO).…”

“…We successfully performed a bronchoscopy-guided intervention therapy with ECMO support for advanced cancer metastasis to the central airway, and the tumor was completely removed by surgery. Although airway oozing and blood clots filled part of the bronchus after the operation, no other complications occurred after adjusting the heparin dose and airway clearing ( 4 ). Although this patient reported in this article eventually died, the specific reasons are complicated.…”

“…Moreover, the irreversible progression of TBM and RP and stent-related complications can also aggravate the original symptoms and disease risks. Despite the aforementioned shortcomings of ECMO, its important role in bronchoscopy-guided interventional therapy is very obvious: first, even though the intervention and anesthesia share the airway, ECMO eliminates the interference of tracheal intubation, providing a more open and clear surgical field; second, it allows the surgeon a longer operation time and more room to perform the surgery in an orderly manner; finally, it maintains stable oxygenation and hemodynamics during surgery ( 4 ). However, hemorrhage commonly occurs during bronchoscopy-guided therapy, and systemic heparinization during ECMO is bound to further increase the risk of coagulopathy, such as major bleeding and embolism.…”

“…The mean arterial pressure, SpO 2 , hematocrit, and activated clotting time (ACT) during transfusion were monitored. The ECMO speed was 3,500 rpm, the blood flow velocity was 3 L/min, the average arterial pressure was maintained at 90 ± 10 mmHg, and ACT was maintained at 250 s ( 4 ). We performed bronchoscopy interventional therapy under general anesthesia with oxygen supply guaranteed by ECMO.…”