Bronchoscopic cryoextraction: a novel approach for the removal of massive endobronchial blood clots causing acute airway obstruction

Abstract

Acute airway obstruction due to large blood clots is known to cause life threatening hypoxemic respiratory failure which can be challenging to diagnose and manage. Different bronchoscopic modalities like rigid bronchoscopy, forceps, snares and catheters can be used to extract these obstructing blood clots but each of these different methods have their own limitations. We describe a patient with iatrogenic endobronchial bleed with acute airway obstruction due to massive blood clot successfully managed using 'cryoextraction'. This technique has been described as the treatment of choice for this clinical situation and this case highlights the fact that this technique can save patients from more aggressive invasive procedures.

Use of a Flexible Cryoprobe for Removal of Tracheobronchial Blood Clots

“…10 The use of cryoprobes for successful extraction of endobronchial blood clots has also been described previously (Table 1). 3,8,9,[11][12][13] There are 2 types of cryoprobes: flexible and rigid. The former can be used through both flexible and rigid bronchoscopes (with a flexible scope inserted through the rigid barrel).…”

Successful Use of Pulmonary Cryotherapy for Tracheobronchial Thrombus Extraction and Recanalization of the Tracheobronchial Tree During a Pediatric Venovenous Extracorporeal Membrane Oxygenation Run

“…Interventional bronchoscopy with cryotherapy extraction has been employed with success in adult patients presenting with obstructing tracheobronchial thrombi. [3][4][5] We reached out to our colleague at the University of Texas Southwestern Medical Center, an adult interventional pulmonologist, Dr. M. Abu-Hijleh, to aid in clearing her airways. Successful heparin-free V-V ECMO using a ROTAFLOW pump and Quadrox oxygenator has been described in adult and pediatric patients.…”

Organized blood clot masquerading as endobronchial tumor: A review of management and recent advances

“…This technique can be used with rigid and flexible bronchoscopy and is commonly indicated for malignant central airway obstruction and low-grade airway malignancy, cryoextraction of foreign bodies with sufficient water content, endobronchial and transbronchial biopsies [ 17 ]. Successful en-bloc removal of large blood clots using cryoextraction was first reported in 2002 by Homasson et al [ 18 ] followed by several case reports [ [19] , [20] , [21] , [22] ]. In 2014, cryotherapy was successfully applied to remove a large blood clot obstructing the left mainstem bronchus bedside in the intensive care unit [ 23 ].…”

“…On the other end of the spectrum are those patients who have significant respiratory compromise requiring mechanical ventilation. Managing such patients is challenging and different bronchoscopic modalities like rigid bronchoscopy, Fogarty catheter dislodgement, forceps, snares and cryoextraction were reported to be successful in the past [ 1 , 6 , 11 , 12 , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] ] However, these modalities are not always readily available and some require expertise. We present a case of an endobronchial organized blood clot that was successfully removed with flexible fiberoptic bronchoscopy using suction and forceps followed by a detailed discussion on the management of such patients.…”