The emergency department evaluation and management of massive hemoptysis

Atchinson, Patricia Ruth; Hatton, Colman J.; Roginski, Matthew A.; Backer, Elliot; Long, Brit; Lentz, Skyler

doi:10.1016/j.ajem.2021.07.041

Cited by 13 publications

(36 citation statements)

References 59 publications

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“…Bronchial artery embolization can be used as a lifesaving intervention in patients with massive airway hemorrhage, with success rates ranging from 82% to 100% to control the bleeding immediately after embolization. 17 Bronchial artery rupture is most common in cases of massive airway hemorrhage. If angiography fails to find bleeding vessels, early empirical bilateral bronchial artery embolization is beneficial to control bleeding and reduce mortality rates.…”

Section: Discussionmentioning

confidence: 99%

“…Although the discontinuation of anticoagulant administration is beneficial for bleeding control, aortography and selective bronchial arteriography should be performed earlier when the tracheal tube is clamped to identify possible bleeding sites and perform vascular embolization. Bronchial artery embolization can be used as a life‐saving intervention in patients with massive airway hemorrhage, with success rates ranging from 82% to 100% to control the bleeding immediately after embolization 17 . Bronchial artery rupture is most common in cases of massive airway hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

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Management of massive airway hemorrhage associated with extracorporeal membrane oxygenation: A retrospective case series study

Zhou

Shi

Guo

2023

Health Science Reports

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Background and Aims: Extracorporeal membrane oxygenation (ECMO) is an important means of treating patients with respiratory failure. Massive airway hemorrhage is a rare complication of ECMO, with high mortality. The aim of this study was to provide a reference for improving the success rate of treatment of this complication by analyzing and summarizing patient clinical data.Methods: We searched PubMed, Medline, and EMBASE databases for case reports of massive airway bleeding associated with ECMO from January 2000 to January 2022 and included one case treated at our facility. All patients were disconnected from the ventilator, and the endotracheal tube was clamped during treatment, resulting in complete airway packing for hemostasis. The clinical data of these patients were analyzed.Results: Through searching and further screening, two works of literature reported four cases that met our inclusion criteria. Including our patient's case, five patients were included in this study (four adults and one neonate). The longest ECMO treatment time before bleeding was 14 days, and the shortest was 20 min. In all patients, conservative treatment was ineffective after a major airway hemorrhage.They were disconnected from the ventilator and the tracheal tube was clamped for 13-72 h. The four adult patients underwent bronchial artery embolization in the interventional radiology suite. All patients' bleeding stopped after treatment; they were successfully weaned off ECMO and discharged. Conclusions: Treatment measures to disconnect the ventilator and clamp the endotracheal tube with full support from ECMO are feasible for massive airway bleeding associated with ECMO. Early bronchial arteriography and embolization can prevent rebleeding.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of massive airway hemorrhage associated with extracorporeal membrane oxygenation: A retrospective case series study

Zhou

Shi

Guo

2023

Health Science Reports

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“…4 The nurse should also anticipate the need for lab studies including a complete blood cell count, comprehensive metabolic panel, coagulation studies, type and cross-match, and arterial blood gas analysis. 6 A portable chest radiograph (CXR) will likely be obtained, and a chest computed tomography (CT) scan (with or without contrast) can help identify bleeding sources not seen on a CXR. standing of this condition is imperative for effective clinical management.…”

Section: Initial Assessments and Interventionsmentioning

confidence: 99%

“…In the absence of a pulmonary bleeding source identified by diagnostic studies, the healthcare team However, the healthcare team must weigh the risks and benefits of transporting the patient to the CT suite. 6 Additionally, flexible bronchoscopy can help localize the bleeding source and be combined with local therapies to temporize the bleeding. Therefore, the nurse should collaborate with a respiratory therapist and prepare for this procedure.…”

Section: Etiologymentioning

confidence: 99%

Caring for patients with life-threatening hemoptysis

Chen,

Fasolka

2024

Nursing

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“…For LTH, it is important to check the patient's airway early and isolate the bleeding immediately to locate and control the bleeding [15]. Selective bronchial intubation and balloon tamponade with a bronchial blocker [1] are good options to control the airway and isolate bleeding in order to localize and control bleeding.…”

Section: Nomogram Model Establishment and Validationmentioning

confidence: 99%

A nomogram to predict life-threatening hemoptysis in patients with tuberculous hemoptysis

Zhu

Fang

et al. 2023

Preprint

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Objectives We aimed to develop and validate a nomogram for predicting life-threatening hemoptysis (LTH) in patients with tuberculous hemoptysis. Methods Patients diagnosed and treated for tuberculous hemoptysis at our hospital during January 2018–December 2020 were retrospectively analyzed. Univariable and binary logistic regression analyses were used to identify independent risk factors for LTH in patients with tuberculous hemoptysis. A predictive nomogram was developed to predict the risk of LTH in the participants. Receiver operating characteristic (ROC) curve analysis, calibration analysis, and decision curve analysis (DCA) were used to evaluate the nomogram. The bootstrapping method was used for internal validation. Results Data from 444 patients were analyzed. Hematocrit (P = 0.005, odds ratio [OR]: 0.912, 95% confidence interval [95% CI]: 0.854–0.972), hemoptysis amount (P < 0.01, OR: 1.005, 95% CI: 1.002–1.007), and lung destruction (P < 0.01, OR: 0.221, 95% CI: 0.099–0.49) were identified as risk factors for LTH. Notably, 50% LTH rate was used as the cut-off to validate the nomogram model. Area under the ROC curve for the nomogram was 0.814 (95% CI: 0.82–0.963). The sensitivity and specificity of the nomogram were 90.1% and 62.5%, respectively. Calibration curve indicated good consistency between the risk predicted using the model and the actual risk. The prediction error was low (integrated Brier score: 0.057). The Hosmer–Lemeshow test yielded a nonsignifcant P-value of 0.634. DCA indicated that the nomogram can be an effective diagnostic tool for predicting LTH. Conclusions The preliminary nomogram could help predict LTH; thus, appropriate decisions can be made to gain more time for patients’ treatment.

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The emergency department evaluation and management of massive hemoptysis

Cited by 13 publications

References 59 publications

Management of massive airway hemorrhage associated with extracorporeal membrane oxygenation: A retrospective case series study

Management of massive airway hemorrhage associated with extracorporeal membrane oxygenation: A retrospective case series study

Caring for patients with life-threatening hemoptysis

A nomogram to predict life-threatening hemoptysis in patients with tuberculous hemoptysis

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