Single site venovenous extracorporeal membrane oxygenation as an alternative to invasive ventilation in post-pneumonectomy fistula with acute respiratory failure

Our plain-English summary of Single site venovenous extracorporeal membrane oxygenation as an alternative to invasive ventilation in post-pneumonectomy fistula with acute respiratory failure, by M. Fica, F. Suárez, R. Aparicio, et al (European Journal of Cardio-thoracic Surgery, 2012).

The study

• Authors: M. Fica, F. Suárez, R. Aparicio, C. Suárez
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 2012;41(4):950-2
• Type of article: Case report
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report the use of venovenous extracorporeal membrane oxygenation with a single dual lumen cannula in a 42-year-old patient suffering from a post-pneumonectomy fistula and severe respiratory insufficiency, avoiding the classical approach of invasive mechanical ventilation. We discussed the potential advantages of extracorporeal oxygenation as the main support in this particular clinical setting.

In plain English

This article was a case report from the Thoracic Surgery Division of Santa María Clinic in Santiago, Chile. It described a 42-year-old man with right malignant pleural mesothelioma, epithelial subtype, who had a right pleuro-pneumo-phreno-pericardectomy. The article did not mention asbestos. About 30 days after surgery, the patient was readmitted with a 1–2 mm fistula (an abnormal opening) in the right bronchial stump. Three repeat attempts to seal it with Beriplast failed. A later sealing with gelatin–formaldehyde–resorcinol glue succeeded, but twelve hours afterwards the patient developed severe breathing failure with pulmonary oedema that did not respond to non-invasive ventilation. Instead of placing a breathing tube, the team used venovenous extracorporeal membrane oxygenation (ECMO, which oxygenates the blood outside the body) through one double-lumen cannula in a neck vein. The patient was never intubated, came off ECMO after 6 days and left intensive care 7 days later. The patient then developed cryptogenic organizing pneumonitis in the left lung, which partly responded to steroids. The authors discussed possible advantages of this approach in this setting.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 42-year-old man treated at Santa María Clinic, Santiago, Chile, for right malignant pleural mesothelioma, epithelial subtype (staged cT2N0M0 before surgery; pT2N1M0 with R0 resection on pathology), who developed a post-pneumonectomy bronchial fistula
• Exposure: Not reported. The article does not mention asbestos or any fiber exposure. It concerns a treatment: venovenous ECMO through a single 31 French double-lumen cannula in the right internal jugular vein, used instead of invasive mechanical ventilation
• Main results:
  • On postoperative day 30 the patient was readmitted, and imaging and bronchoscopy showed a 1–2 mm fistula in the short right bronchial stump
  • Attempts to close the fistula by bronchoscopy were repeated three times over 2 weeks without success
  • Twelve hours after sealing with gelatin–formaldehyde–resorcinol glue, the patient developed massive mucous bronchorrhea and severe respiratory impairment
  • The patient had pulmonary oedema with hypoxia that did not respond to non-invasive ventilation, with a PaO2/FiO2 ratio of 77
  • Venovenous ECMO was installed through the right internal jugular vein without intubation, and the patient was not intubated at any time
  • The patient was weaned off ECMO after 6 days, once able to sustain a PaO2/FiO2 ratio greater than 150 for more than 6 hours without rapid breathing
  • No significant complications from cannula position, bleeding, recirculation or membrane thrombosis were reported
  • The patient left the ICU seven days after weaning
  • The patient later developed cryptogenic organizing pneumonitis in the left lung, which had a partial response to steroids. Functional status remained at ECOG 2 to 3
• The authors' conclusion: The authors reported using single-cannula venovenous ECMO, planned in advance, as an alternative to invasive mechanical ventilation to avoid intubation in this patient. They discussed its potential advantages in patients with a post-pneumonectomy fistula and acute respiratory failure

Topics

Medical terms in this study, explained in our Lexicon: Pneumonectomy.

Related studies

• Transsternal transpericardial operations in the treatment of bronchopleural fistulas after pneumonectomy — G. Stamatis, G. Martini, et al. (1996)
• Amplatzer Device in Bronchial Stump Fistula after Extrapleural Pneumonectomy — J. Turtiainen, J.V. Räsänen, et al. (2016)
• Treatment of bronchial fistula after extraplural pneumonectomy using flexible bronchoscopy with the administration of OK432, fibroblast growth factor basic and fibrin glue sealant — N. Kondo, M. Hashimoto, et al. (2020)
• Digital quantification of air leak to identify the location of an alveolopleural fistula — T.M. Saettele, C.A. Jimenez (2014)
• Squamous cell carcinoma arising from the pleura after pneumonectomy for squamous cell carcinoma of the lung — M. Franke, H.D. Chung, et al. (2010)
• Patterns of failure, toxicity, and survival after extrapleural pneumonectomy and hemithoracic intensity-modulated radiation therapy for malignant pleural mesothelioma — D.R. Gomez, D.S. Hong, et al. (2013)

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