Cardiopulmonary bypass as a bridge for bronchial foreign body removal in a child with pulmonary artery sling

Abstract

Rationale:Successful removal of an airway foreign body (FB) in some intractable cases can be very challenging, because of tracheal anomalies, unstable respiratory status of the patients, and the location of FB. The use of cardiopulmonary bypass (CPB) support for the treatment of a FB is extremely rare.Patient concerns:We present a case of a 39-month-old previously healthy girl who was admitted to our hospital for suspected FB aspiration (FBA). Initially, the attempt for removal of the FB by conventional bronchoscopy failed because of hypoxic intolerance.Diagnoses:Bronchoscopy revealed tracheal anomalies and subsequent computed tomography angiography demonstrated the presence of a pulmonary artery sling (PAS), which confirmed the diagnosis of PAS accompanied with FBA.Interventions:With the assistance of CPB, multidisciplinary treatment involving the respiratory, cardiothoracic and anesthetic teams were involved and the bronchial FB was removed by flexible bronchoscopy successfully and then PAS was corrected by surgical intervention.Outcomes:The patient remained asymptomatic, without shortness of breath or wheezing during the 15 months follow-up.Lessons:This case highlights that in a complicated case of FBA, bronchoscopy and computed tomography imaging are of great importance to achieve an accurate diagnosis, and a multidisciplinary treatment approach is essential for a satisfactory outcome. If the patient is unstable for bronchoscopy, CPB can be temporarily used in the stabilization of the patient to allow safe removal of the FB.

Use of extracorporeal membrane oxygenation for bronchoscopic removal of a tracheal foreign body in a child

“…In theory, cardiopulmonary bypass, which is more widely available than extracorporeal membrane oxygenation, could be and has been used for foreign body removal. 3 In some reported instances, 4 an open operation with a cardiopulmonary bypass was indicated because there was a vascular sling tracheal obstruction as well as a foreign body. However, cardiopulmonary bypass requires arterial cannulation with attendant risks, and full heparinisation risks haemorrhage.…”