Respiratory support with venovenous extracorporeal membrane oxygenation during stent placement for the palliation of critical airway obstruction: case series analysis

Park, Jung Hoon; Shin, Ji Hoon; Kim, Kun Yung; Lim, Ju Yong; Kim, Pyeong Hwa; Tsauo, Jiaywei; Kim, Min Tae

doi:10.21037/jtd.2017.06.88

Cited by 20 publications

(26 citation statements)

References 23 publications

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“…Recently, we treated 150 new patients with benign or malignant TBS and performed 400 rigid bronchoscopies in one year. Although we do not use SEMS in any type of TBS due to their disadvantages, some other institutions in South Korea use SEMS in patients with benign TBS as well as those with malignant TBS [20][21][22]. The use of SEMS in patients with benign TBS is controversial, therefore, we retrospectively reviewed the charts of 20 patients who experienced complications with SEMS.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Complications Following Self-Expandable Metallic Stent Insertion for Benign Tracheobronchial Stenosis

Jeong

et al. 2020

Medicina

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Background and Objectives: The use of metallic stents in benign TBS is controversial. Here, we report the clinical outcomes of patients who developed complications due to self-expandable metallic stent (SEMS) insertion for benign TBS. Materials and Methods: Our institution, which is the largest and most active referral hospital for airway stenosis in South Korea, only uses silicone stents. We conducted a retrospective review of 20 patients referred after the insertion of SEMS for benign TBS from 2006 to 2015. Results: All 20 patients underwent rigid bronchoscopy for SEMS removal due to airway obstruction from granulation tissue overgrowth. All but one (95%) experienced successful removal of the SEMS. During a median follow-up period of 40 months, a median of seven rigid bronchoscopies per patient was needed to maintain airway patency. Three (15%) patients suffered acute complications during SEMS removal (bleeding (10%) and fistula (5%)). All patients suffered chronic complications (granulation tissue (80%), stent migration (58%), mucostasis (55%), and restenosis (43%)). Eventually, 15 patients (75%) needed airway prostheses (silicone stent (75%) and tracheostomy (25%)). Conclusion: Our findings indicate that SEMS should be avoided until positive results are consistently reported by high-quality studies in patients with benign TBS.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Complications Following Self-Expandable Metallic Stent Insertion for Benign Tracheobronchial Stenosis

Jeong

et al. 2020

Medicina

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“…Most of their patients (94.7%) were successfully weaned off ECMO, and death related to complications of ECMO was seen in only one patient. Another report and review of existing literature, 10 noting the apparently good outcome in many reported cases, suggested ECMO for acute severe tracheal obstruction. In another report from Spain, 11 ECMO was used successfully in a case of severe life-threatening airway obstruction due to complications of inflammatory bowel disease.…”

Section: Discussionmentioning

confidence: 98%

Usefulness of extracorporeal membrane oxygenation in status asthmaticus with severe tracheal stenosis

Odigwe

Krieg

Owens

et al. 2020

Baylor University Medical Center Proceedings

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Extracorporeal membrane oxygenation, traditionally used to treat refractory hypoxemic respiratory failure due to acute respiratory distress syndrome, is being used to treat other etiologies of severe respiratory failure refractory to conventional mechanical ventilation. We present a 30-year-old woman with concomitant life-threatening airway obstruction due to severe tracheal stenosis and status asthmaticus treated effectively with veno-venous extracorporeal membrane oxygenation. KEYWORDS Acute severe asthma; extracorporeal membrane oxygenation; tracheal stenosisO bstruction of the central airways, the trachea and mainstem bronchi, can complicate many disease processes and in tracheal stenosis can be a complication of prior tracheostomy placement due to excess scar tissue formation. Asthma is an allergic condition characterized by bronchoconstriction with periods of exacerbation and remission. During severe exacerbations, patients may need mechanical ventilation. Severe asthma exacerbation in a patient with a compromised central airway due to tracheal stenosis can be challenging to manage. Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) involves diversion of blood for extracorporeal oxygenation and carbon dioxide removal by an artificial "membrane lung" and is a salvage treatment for respiratory failure. There are reports of successful outcomes where VV ECMO has enabled performance of lifesaving procedures in high-risk patients with central airway obstruction. 1

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“…They verified the feasibility of stent placement under ECMO support but mean survival time was only four months. 6 These unsatisfying results raise questions about the futility of intensive respiratory support, including ECMO and mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

Successful use of extracorporeal membrane oxygenation for airway‐obstructing lung adenocarcinoma

et al. 2020

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Endobronchial-invasive lung cancers are generally diagnosed at advanced stages and may require emergency treatment for airway obstruction. Stent implantation is a common intervention for such obstructed airways but certain subsets of patients cannot receive adequate treatment without respiratory support. Venovenous extracorporeal membrane oxygenation (ECMO) is a salvage therapy for respiratory failure but its usefulness in managing patients with advanced lung cancer remains unclear given the poor prognosis. In recent years, molecular targeted agents for patients with driver mutations offer rapid responses and may be administered even while under critical care. In this report, we describe the case of 39-year-old female who presented to our emergency department with severe respiratory distress. A computed tomography scan revealed a large mediastinal tumor invading the tracheal carina causing severe stenosis of the left main bronchus and right main pulmonary artery. ECMO support was required as the respiratory condition remained unstable despite high pressure ventilation. Under ECMO support, the patient underwent bronchial stent implantation and was successfully weaned off ECMO. The tumor was histologically diagnosed as pulmonary adenocarcinoma with anaplastic lymphoma kinase gene rearrangement. Treatment with a tyrosine kinase inhibitor, alectinib, induced a marked tumor reduction within a short period. The patient recovered well and is now in remission one year later. This case indicates that intensive respiratory support with ECMO may become a bridge through the critical period for selected patients with respiratory failure secondary to advanced lung cancer. Key points Significant findings of this study: ECMO was important to maintain oxygenation during airway intervention for acute respiratory failure due to critical lung adenocarcinoma with ALK gene rearrangement. What this study adds: With the development of targeted therapies and the improvement in therapeutic bronchoscopy, intensive respiratory support with ECMO may be helpful especially in selected lung cancer patients with oncogenic driver mutations.

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Respiratory support with venovenous extracorporeal membrane oxygenation during stent placement for the palliation of critical airway obstruction: case series analysis

Cited by 20 publications

References 23 publications

Clinical Outcomes of Complications Following Self-Expandable Metallic Stent Insertion for Benign Tracheobronchial Stenosis

Clinical Outcomes of Complications Following Self-Expandable Metallic Stent Insertion for Benign Tracheobronchial Stenosis

Usefulness of extracorporeal membrane oxygenation in status asthmaticus with severe tracheal stenosis

Successful use of extracorporeal membrane oxygenation for airway‐obstructing lung adenocarcinoma

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