Massive hemoptysis successfully treated with extracorporeal membrane oxygenation and endobronchial thrombolysis

ABSTRACT Extracorporeal membrane oxygenation has been used to treat refractory hypoxemia in numerous clinical scenarios. The fundamental principles for the management of massive hemoptysis patients include protecting the airway and healthy lung, locating the source of bleeding and controlling the hemorrhage. We report the case of a patient with acute respiratory failure associated with massive hemoptysis secondary to lung laceration during cardiac surgery. The use of extracorporeal membrane oxygenation allowed patient survival. However, due to the great difficulty in managing pulmonary clots after hemoptysis, it was necessary to use an unusual therapy involving endobronchial infusion of a thrombolytic agent as described in rare cases in the literature.

【摘要】体外膜肺氧合（Extracorporeal membrane oxygenation）已被应用于多种临床场景下难治性低氧血症（refractory hypoxemia）的救治。大咯血（massive hemoptysis）患者的管理基本原则包括保护气道与健侧肺、明确出血源头并控制出血。本文报告1例心脏手术（cardiac surgery）期间因肺裂伤（lung laceration）继发大咯血，进而并发急性呼吸衰竭（acute respiratory failure）的患者。体外膜肺氧合的应用使该患者得以存活。然而，由于咯血后肺部血凝块的管理难度极大，需采用经支气管内输注（endobronchial infusion）溶栓药物（thrombolytic agent）这一非常规治疗手段，此类疗法在现有文献中仅见罕见病例报道。