Korean J Crit Care Med.  2016 Feb;31(1):54-57. 10.4266/kjccm.2016.31.1.54.

The Use of Extracorporeal Membrane Oxygenation in the Surgical Repair of Bronchial Rupture

• Park JH
• Lim J
• Lee J
• Lee HS

• KMID: 2227614
• DOI: http://doi.org/10.4266/kjccm.2016.31.1.54

Abstract

Extracorporeal membrane oxygenation (ECMO) has been used successfully in critically ill patients with traumatic lung injury and offers an additional treatment modality. ECMO is mainly used as a bridge treatment to delayed surgical management; however, only a few case reports have presented the successful application of ECMO as intraoperative support during the surgical repair of traumatic bronchial injury. A 38-year-old man visited our hospital after a blunt chest trauma. His chest imaging showed hemopneumothorax in the left hemithorax and a finding suspicious for left main bronchus rupture. Bronchoscopy was performed and confirmed a tear in the left main bronchus and a congenital tracheal bronchus. We decided to provide venovenous ECMO support during surgery for bronchial repair. We successfully performed main bronchial repair in this traumatic patient with a congenital tracheal bronchus. We suggest that venovenous ECMO offers a good option for the treatment of bronchial rupture when adequate ventilation is not possible.

Keyword

blunt injury; extracorporeal membrane oxygenation; lung injury; trauma

MeSH Terms

Adult
Bronchi
Bronchoscopy
Critical Illness
Extracorporeal Membrane Oxygenation*
Hemopneumothorax
Humans
Lung Injury
Rupture*
Tears
Thorax
Ventilation
Wounds, Nonpenetrating

Figure

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  Fig. 1. Chest radiograph taken in the emergency department showing pneumothorax in the left lung.

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  Fig. 2. Transverse (A and B) chest computed tomography images showing hemopneumothorax in the left hemithorax, fracture in the left sixth rib, and multifocal ground glass opacity and nodules in both lungs.

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  Fig. 3. Intraoperative photograph of the detachment of the left main bronchus from the lower 3 cm to the carina and a longitudinal opening at the proximal portion of the left main bronchus.

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  Fig. 4. Bronchoscopy images showing an intact left main bronchus anastomosis site (A) and the origin of the right upper bronchus at the lateral tracheal wall (B).

Reference

References

1. Cordell-Smith JA, Roberts N, Peek GJ, Firmin RK. Traumatic lung injury treated by extracorporeal membrane oxygenation (ECMO). Injury. 2006; 37:29–32.

2. Sian K, McAllister B, Brady P. The use of extracorporeal membrane oxygenation therapy in the delayed surgical repair of a tracheal injury. Ann Thorac Surg. 2014; 97:338–40.

3. Liu C, Lin Y, Du B, Liu L. Extracorporeal membrane oxygenation as a support for emergency bronchial reconstruction in a traumatic patient with severe hypoxaemia. Interact Cardiovasc Thorac Surg. 2014; 19:699–701.

4. Ried M, Bein T, Philipp A, Müller T, Graf B, Schmid C, et al. Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience. Crit Care. 2013; 17:R110.

5. Korvenoja P, Pitkänen O, Berg E, Berg L. Veno-venous extracorporeal membrane oxygenation in surgery for bronchial repair. Ann Thorac Surg. 2008; 86:1348–9.

6. Peragallo RA, Swenson JD. Congenital tracheal bronchus: the inability to isolate the right lung with a univent bronchial blocker tube. Anesth Analg. 2000; 91:300–1.

7. Ventetuolo CE, Muratore CS. Extracorporeal life support in critically ill adults. Am J Respir Crit Care Med. 2014; 190:497–508.