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Published on: January 17, 2011
Flexible and Rigid Bronchoscopy for Critically Ill Children on Extracorporeal Membrane Oxygenation
Ashley Young1, Krupa Patel1,2, Kiona Allen1,3
1Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A.
Insights
Bronchoscopy in children on extracorporeal membrane oxygenation (ECMO) may aid decannulation but carries risks. Adverse events are linked to procedure number and airway obstruction, not ECMO type.
Area of Science:
- Pediatric Critical Care Medicine
- Interventional Pulmonology
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure for critically ill children.
- Tracheobronchial obstruction can complicate ECMO support and hinder decannulation.
- Bronchoscopy is a potential tool for diagnosing and managing airway issues in this population.
Purpose of the Study:
- To evaluate the experience and outcomes of bronchoscopy in children requiring ECMO.
- To assess the safety and efficacy of bronchoscopy for relieving tracheobronchial obstruction prior to decannulation.
- To identify factors associated with adverse events during bronchoscopy in ECMO patients.
Main Methods:
- Retrospective cohort study of children on ECMO from January 2018 to December 2022.
- Analysis of 99 bronchoscopies performed on 37 patients during ECMO support.
- Comparison of outcomes and adverse events between patients who underwent bronchoscopy and those who did not.
Main Results:
- 35% of ECMO patients underwent 99 bronchoscopies.
- Clinical improvement in tidal volumes was observed in 13/25 patients post-bronchoscopy (p=0.05).
- Adverse events (pneumothorax, pneumonia, hemorrhage, sepsis) occurred in 49% of patients; associated with procedure number and obstruction.
- ECMO duration was longer and complication rates higher in patients who underwent bronchoscopy.
- Mortality rates were similar between groups.
Conclusions:
- Children needing bronchoscopy on ECMO are critically ill.
- Bronchoscopy can benefit children with persistent cardiopulmonary failure, aiding decannulation.
- The number of bronchoscopies and presence of obstructive material are key factors for adverse events.
Background:
We aim to describe our experience with bronchoscopy to diagnose and relieve tracheobronchial obstruction in anticipation of decannulation in children on extracorporeal membrane oxygenation (ECMO) support.
Methods:
A retrospective cohort study of children on ECMO between 1/2018 and 12/2022.
Results:
A total of 107 children required ECMO support during the study period for cardiac (n = 48, 45%), pulmonary (n = 38, 36%), or cardiopulmonary dysfunction (n = 21, 20%). Thirty-seven (35%) patients underwent 99 bronchoscopies while on ECMO. Most (76%, n = 75) experienced no improvement or worsening of chest radiography 24 hours following bronchoscopy. Clinical improvement in tidal volumes 48 hours after the first bronchoscopy was noted in 13/25 patients with available data (p = 0.05). Adverse events were seen in 18 (49%) patients who underwent bronchoscopy, including pneumothorax (n = 8, 22%), pneumonia (n = 7, 19%), pulmonary hemorrhage (n = 6, 16%), and sepsis (n = 5, 14%). ECMO courses were longer (25.4 ± 37.2 vs 6.1 ± 8.8 days, p < 0.0001) and more likely to be complicated by pneumonia (p = 0.0004) and sepsis (p = 0.047) in patients who underwent bronchoscopy compared with those who did not. Adverse events following bronchoscopy were associated with the number of bronchoscopies (p = 0.0003) and the presence of obstructive materials but not with the type of bronchoscopy or indication for ECMO. Mortality rates were similar between patients who underwent bronchoscopy and those who did not.
Conclusion:
Children requiring bronchoscopy represent a subset of the sickest children on ECMO. Bronchoscopy may provide benefit in children with persistent cardiopulmonary failure who could not otherwise be decannulated. Adverse events are associated with the number of bronchoscopies and the presence of obstructive material.
Level Of Evidence:
4 Laryngoscope, 134:4134-4140, 2024.
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