Case report: Foreign body aspiration requiring extracorporeal membrane oxygenation

Abstract

IntroductionForeign body aspiration is a common cause of respiratory distress in pediatrics, but the diagnosis can be challenging given aspirated objects are mostly radiolucent on chest radiographs and there is often no witnessed choking event. We present a case of a patient who was initially managed as severe status asthmaticus, requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for refractory hypercarbia and hypoxemia, but was later found to have bilateral bronchial foreign body aspiration. This case is unique in its severity of illness, diagnostic dilemma with findings suggesting a more common diagnosis of asthma, and use of ECMO as a bridge to diagnosis and recovery.Patient caseA previously healthy 2-year-old boy presented during peak viral season with a 3-day history of fever, cough, coryza, and increased work of breathing over the prior 24 h. There was no reported history of choking or aspiration. He was diagnosed with asthma and treated with bronchodilator therapy. Physical examination revealed pulsus paradoxus, severe work of breathing with bilateral wheeze, and at times a silent chest. Chest radiographs showed bilateral lung hyperinflation. Following a brief period of stability on maximum bronchodilator therapies and bilevel positive pressure support, the patient had a rapid deterioration requiring endotracheal intubation, with subsequent cannulation to VA-ECMO. A diagnostic flexible bronchoscopy was performed and demonstrated bilateral foreign bodies, peanuts, in the right bronchus intermedius and the left mainstem bronchus. Removal of the foreign bodies was done by rigid bronchoscopy facilitating rapid wean from VA-ECMO and decannulation within 24 h of foreign body removal.ConclusionForeign body aspiration should be suspected in all patients presenting with atypical history and physical examination findings, or in patients with suspected common diagnoses who do not progress as expected or deteriorate after a period of stability. Extracorporeal life support can be used as a bridge to diagnosis and recovery in patients with hemodynamic or respiratory instability.

A pediatric patient with bilateral tracheobronchial foreign body successfully treated using surgical intervention with extracorporeal circulation: case report and literature review

“…Ginter et al, successfully removed bilateral TFB using fiberoptic bronchoscopy with VA-ECMO life support ( 2 ). Upon admission, the patient presented with cyanosis, respiratory distress, and a pallid complexion.…”

The global, regional, and national burden of foreign bodies from 1990 to 2019: a systematic analysis of the global burden of disease study 2019

“…Among them, the most common complications of FBs in the eye are blindness or loss of eyeballs and unilateral visual impairment [ 2 , 10 ]. The long-term complications of PAFBA include atelectasis, pneumonia, and bronchiectasis, and the most serious complications are apnea caused by hypoxia, ischemic hypoxic encephalopathy, and death [ 11 ]. FBs in other parts of the body, such as FBs in the digestive tract, may cause gastrointestinal bleeding, perforation, and ulcers, and its most serious complications are sepsis and septic shock leading to intestinal necrosis [ 12 ].…”