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

Affiliations
  • 1Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
  • 2Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea.
  • 3Department of Thoracic and Cardiovascular Surgery, Sahmyook Medical Center, Seoul, Korea.
  • 4Department of Thoracic and Cardiovascular Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea. lheecs@hallym.or.kr

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

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

  • 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.

  • 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.

  • 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

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