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

Abstract

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.

Hybrid emergency room: Installation, establishment, and innovation in the emergency department

“…The cannulae can be immediately and safely positioned with use of moveable C-arm fluoroscopy and ultrasonography equipment soon after early CT examination. As some researchers have reported, [17][18][19][20] initiation of VA or VV ECMO in the hybrid ER could be a safe and highly effective treatment to rescue severely injured or ill patients.…”

“…Among patients with severe illness, Matsumura et al reported a rare case of negative pressure pulmonary edema, which is a potentially life‐threatening complication of general anesthesia with tracheal intubation. Because the patient could not be optimally managed with mechanical ventilation, VV ECMO could be started within 18 min of the patient's arrival in the hybrid ER without complications, and cardiopulmonary arrest was prevented 19 . In patients with massive pulmonary embolism (PE) requiring extracorporeal cardiopulmonary resuscitation (ECPR), safe and prompt initiation of VA ECMO is essential.…”

Severe re-expansion pulmonary oedema requiring veno-venous extracorporeal membrane oxygenation treatment

“…One recent study reported an incidence of 21.6% in patients with a lung collapse duration longer than 4 days and severe lung collapse. The acute clinical course of REPE resembles that of negative pressure pulmonary oedema, another possible aetiology of non-cardiogenic pulmonary oedema, which may also occasionally require VV-ECMO therapy 3. The recommended clinical management is supportive care consisting of non-invasive positive-pressure ventilation, as well as mechanical ventilation, if necessary.…”

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.…”