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

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.

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Near-fatal negative pressure pulmonary oedema successfully treated with venovenous extracorporeal membrane oxygenation performed in the hybrid emergency room

BMJ Case Reports ◽

10.1136/bcr-2020-234651 ◽

2020 ◽

Vol 13 (9) ◽

pp. e234651 ◽

Cited By ~ 1

Author(s):

Kazuki Matsumura ◽

Yukitoshi Toyoda ◽

Shokei Matsumoto ◽

Tomohiro Funabiki

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Emergency Room ◽

Pulmonary Oedema ◽

Negative Pressure ◽

Ct Scanner ◽

Resuscitation Room ◽

Membrane Oxygenation ◽

First Case ◽

Negative Pressure Pulmonary Oedema ◽

Venovenous Extracorporeal Membrane Oxygenation

We report a rare case of negative pressure pulmonary oedema (NPPE), a life-threatening complication of tracheal intubation. A 41-year-old obese man was admitted to a previous hospital for neck surgery. After extubation, he developed respiratory distress followed by haemoptysis and desaturation. The patient was reintubated and brought to our hospital where we introduced venovenous extracorporeal membrane oxygenation (ECMO) to prevent cardiac arrest, which is an unusual clinical course for NPPE. He returned to his routine without any sequelae. This is the first case report of NPPE successfully resolved with venovenous ECMO in the hybrid emergency room (hybrid ER), which is a resuscitation room equipped with interventional radiology features and a sliding CT scanner. Since the hybrid ER serves as a single move for patients where all necessary procedures are performed, it has the potential to lower the incidence of cannulation complications, beyond the delay in ECMO initiation.

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Intraoperative Venovenous Extracorporeal Membrane Oxygenation as Rescue for a Patient With an Inhalational Burn and Iatrogenic Upper Airway Injury

A & A Practice ◽

10.1213/xaa.0000000000000747 ◽

2018 ◽

Vol 11 (5) ◽

pp. 115-117

Author(s):

Corinne A. Davis ◽

Alexander D. Paladino ◽

William B. Lassiter ◽

Arun Sharma ◽

Kevin M. Brady

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Upper Airway ◽

Membrane Oxygenation ◽

Airway Injury ◽

Venovenous Extracorporeal Membrane Oxygenation

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Use of Thromboelastogram in Venovenous Extracorporeal Membrane Oxygenation for a Patient with Pulmonary Hemorrhage due to Microscopic Polyangiitis

Case Reports in Critical Care ◽

10.1155/2019/7241264 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Chak-Kwan Tong ◽

Jun Jin ◽

Qian Du

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Microscopic Polyangiitis ◽

Pulmonary Hemorrhage ◽

Activated Partial Thromboplastin Time ◽

Clotting Time ◽

Heparin Dose ◽

Heparin Infusion ◽

Membrane Oxygenation ◽

Activated Clotting Time ◽

Venovenous Extracorporeal Membrane Oxygenation

Systemic heparinisation is required for extracorporeal membrane oxygenation therapy, to prevent clotting of circuit and formation of thrombus in patient. Activated clotting time (ACT) or activated partial thromboplastin time (aPTT) has been the mainstay of monitoring of heparin dose. Thromboelastogram (TEG) is increasingly being used again in recent years with the advancement in technology. Its clinical usefulness in the monitoring of anticoagulation of ECMO therapy is demonstrated in the case presented. Our patient suffered from severe hemoptysis due to active microscopic polyangiitis and respiratory failure. Heparin infusion was given at the initiation of ECMO support without further aggravation of hemoptysis. Dose of heparin was adjusted successfully with the integration of the clotting profile and TEG results.

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