Intractable Bleeding Following an Awake Bedside Injection Laryngoplasty in a Patient on KVAD ECMO.

Area of Science:

• Otolaryngology
• Cardiothoracic Surgery
• Critical Care Medicine

Background:

• Awake injection laryngoplasty (IL) is increasingly used for vocal fold immobility post-cardiothoracic surgery.
• Complication rates for awake IL are typically low (<3%), with significant bleeding rarely reported.
• This report focuses on a rare complication in a specific patient population.

Observation:

• A patient on Koji Takeda Ventricular Assist Device (KVAD) extracorporeal membrane oxygenation (ECMO) developed intractable bleeding post-bedside IL.
• Bleeding originated from the vocal fold injection site and required reintubation and interventions for hemostasis.
• The patient required multiple blood transfusions over the week following the procedure.

Findings:

• This case demonstrates intractable hemorrhage following awake IL in a patient supported by KVAD ECMO.
• The bleeding necessitated intubation and repeated interventions, including epi-pledgets and hemostatic matrix, to achieve hemostasis.
• The patient required 5 units of packed red blood cells due to the hemorrhage.

Implications:

• This case underscores the potential for severe bleeding complications with awake IL in patients on ECMO.
• It highlights the importance of carefully assessing the risk-benefit ratio before performing IL in critically ill patients with mechanical circulatory support.
• Further research may be needed to establish specific guidelines for IL in patients on ECMO or similar devices.