Venovenous Extracorporeal Membrane Oxygenation for Negative Pressure Pulmonary Hemorrhage in an Elderly Patient

Abstract

The patient in this case report was an 88-year-old male. Acute upper airway obstruction by food led to transient cardiac arrest, and negative pressure pulmonary hemorrhage (NPPH) occurred 1 hour after the foreign body obstruction. Using venovenous extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome resulting from NPPH, his respiratory state was recovered and hemoptysis stopped. NPPH is a life-threatening disease, the rapid recognition of which is required to initiate appropriate therapy. Although active hemorrhage might be a contraindication for ECMO, our experience showed this to be an effective treatment option. Moreover, our experience suggests that the application of ECMO to elderly patients should be considered on a case-by-case basis.

Extraordinary Delayed-Onset Negative Pressure Pulmonary Hemorrhage Resulting in Cardiac Arrest after General Anesthesia for Vocal Cord Polypectomy

“…In the treatment of NPPE, sufficient oxygenation or noninvasive positive pressure ventilation is effective, and reintubation is sometimes necessary in severe cases; however, cases requiring extracorporeal membrane oxygenation have rarely been reported [14][15][16]. The cause of postoperative pulmonary edema is either cardiogenic or noncardiogenic [17].…”

Extracorporeal Membrane Oxygenation as Acute Rescue Therapy for Negative Pressure Pulmonary Edema in the Post Anesthesia Care Unit: A Case Report

“…Conventional treatment of severe NPPE is focused on relieving the upper airway obstruction, positive pressure ventilation, and medication therapy including diuretics, with resolution of most cases. Case reports have described the need for delayed veno-venous extracorporeal membrane oxygenation (VV ECMO) in cases of refractory hypoxia not responding to initial therapies 2,3,4,5 . However, the use of VV ECMO as acute rescue therapy in the post anesthesia care unit (PACU) for NPPE-induced severe hypoxic respiratory failure, shock, and peri-arrest physiology is yet to be described in the literature.…”

Extracorporeal membrane oxygenation as acute rescue therapy for negative pressure pulmonary edema in the post anesthesia care unit: A case report

“…Conventional treatment of severe NPPE is focused on relieving the upper airway obstruction, positive pressure ventilation, and medication therapy including diuretics, with resolution of most cases. Case reports have described the need for delayed veno‐venous extracorporeal membrane oxygenation (VV ECMO) in cases of refractory hypoxia not responding to initial therapies 2–5 . However, the use of VV ECMO as acute rescue therapy in the post anesthesia care unit (PACU) for NPPE‐induced severe hypoxic respiratory failure, shock, and peri‐arrest physiology is yet to be described in the literature.…”

“…Case reports have described the need for delayed veno‐venous extracorporeal membrane oxygenation (VV ECMO) in cases of refractory hypoxia not responding to initial therapies. 2 , 3 , 4 , 5 However, the use of VV ECMO as acute rescue therapy in the post anesthesia care unit (PACU) for NPPE‐induced severe hypoxic respiratory failure, shock, and peri‐arrest physiology is yet to be described in the literature.…”