Massive hemoptysis bridged with VV ECMO: A case report

Area of Science:

• Critical Care Medicine
• Pulmonary Medicine
• Cardiovascular Medicine

Background:

• Extracorporeal membrane oxygenation (ECMO) offers vital pulmonary support.
• Veno-venous ECMO (VV ECMO) is a key intervention for acute respiratory distress.
• Managing massive hemoptysis in ECMO patients presents unique challenges.

Observation:

• A 42-year-old male on VV ECMO for ARDS developed massive hemoptysis.
• Bleeding originated from bilateral bronchi, necessitating urgent intervention.
• The patient required 14 bronchoscopies for clot removal.

Findings:

• Temporary discontinuation of mechanical ventilation allowed tamponade of bleeding bronchi.
• VV ECMO provided continuous respiratory support during apneic periods.
• Serial declotting bronchoscopies successfully managed hemoptysis without recurrence.

Implications:

• This case highlights a novel strategy for managing massive hemoptysis in VV ECMO patients.
• Temporary apnea combined with VV ECMO and bronchoscopy is a viable treatment approach.
• This technique can improve outcomes for critically ill patients with severe hemoptysis.