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Post-pneumonectomy video-assisted thoracoscopic bullectomy using extra-corporeal membrane oxygenation
I F Oey1, G J Peek, R K Firmin
1Department of Thoracic Surgery, Glenfield Hospital, Leicester LE3 9QP, UK.
Summary
A patient developed a critical air leak in their remaining lung 14 years after pneumonectomy due to intubating an emphysematous bulla. Veno-venous extra-corporeal membrane oxygenation (ECMO) facilitated life-saving video-assisted thoracoscopic surgery.
Area of Science:
- Thoracic Surgery
- Pulmonary Medicine
- Critical Care Medicine
Background:
- Pneumonectomy significantly alters pulmonary mechanics and surgical risk.
- Emphysematous bullae represent a vulnerable lung area prone to injury.
- Accidental intubation of bullae can lead to severe complications.
Observation:
- A patient presented with a life-threatening air leak 14 years post-pneumonectomy.
- The complication arose from accidental intubation of an emphysematous bulla in the remaining lung.
- This necessitated urgent surgical intervention.
Findings:
- Video-assisted thoracoscopic surgery (VATS) was employed for definitive management.
- Veno-venous extra-corporeal membrane oxygenation (VV-ECMO) provided crucial hemodynamic and respiratory support.
- Successful surgical repair of the air leak was achieved.
Implications:
- Highlights the long-term risks associated with pneumonectomy and bullous disease.
- Demonstrates the utility of VV-ECMO in managing complex thoracic surgical emergencies.
- Emphasizes the importance of careful intubation techniques in patients with prior lung resections.