Hemodynamic Instability Following Airway Spray Cryotherapy

Area of Science:

• Pulmonology
• Interventional Pulmonology
• Thoracic Surgery

Background:

• Spray cryotherapy (SCT) is utilized for palliation of respiratory symptoms in patients with obstructive airway lesions.
• Significant intraoperative hemodynamic complications have been associated with SCT.
• This study reviews institutional experience with SCT for obstructive airway tumors.

Purpose of the Study:

• To evaluate the incidence and nature of intraoperative and postoperative hemodynamic complications associated with spray cryotherapy (SCT) in patients with obstructive airway tumors.

Main Methods:

• A retrospective review of patients undergoing SCT for obstructive airway tumors at a single institution.
• Descriptive statistics were used to analyze patient demographics, tumor characteristics, procedure details, and hemodynamic complications.

Main Results:

• 34 SCT sessions were performed on 28 patients (median age 60 years) for various airway tumors.
• 31% of sessions resulted in severe hypotension and/or bradycardia, with 2 patients requiring cardiopulmonary resuscitation.
• Two deaths occurred within 24 hours of SCT, and four patients needed mechanical ventilation.

Conclusions:

• Endobronchial SCT can lead to unpredictable, life-threatening hemodynamic instability, likely caused by pulmonary venous gaseous emboli.
• While SCT offers potential advantages over laser therapy, further research is required to balance its therapeutic benefits against the risk of catastrophic complications.