Feasibility of transbronchial lung cryobiopsy in patients with veno-venous extracorporeal membrane oxygenation support

Shiyao Wang, Guowu Zhou, Yingying Feng, Yi Zhang, Ye Tian, Sichao Gu, Xiaojing Wu, Meiyuan Li, Yiming Feng, Dan Wang, Ying Li, Zheng Tian, Ling Zhao, Min Li, Wenhui Chen, Xu Huang, Qingyuan Zhan, Shiyao Wang, Guowu Zhou, Yingying Feng, Yi Zhang, Ye Tian, Sichao Gu, Xiaojing Wu, Meiyuan Li, Yiming Feng, Dan Wang, Ying Li, Zheng Tian, Ling Zhao, Min Li, Wenhui Chen, Xu Huang, Qingyuan Zhan

Abstract

Background: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is essential life support in patients with severe acute hypoxaemic respiratory failure. However, biopsies should be considered for some patients with unknown aetiology. This study aims to evaluate the feasibility of transbronchial lung cryobiopsy (TBLC) in such patients.

Methods: All patients with acute hypoxaemic respiratory failure of unknown aetiology who underwent TBLC with VV-ECMO support were retrospectively reviewed. Patients' characteristics, ventilation settings, procedure parameters, complications, pathological diagnosis and survival were summarised and analysed.

Results: Eight female and five male patients with VV-ECMO support underwent TBLC. The median age was 58 (interquartile range (IQR) 38-67) years old. Concurrent diseases were present in 10 of the 13 patients, seven of which were immunosuppressed. The median time between biopsy and VV-ECMO establishment was 2.0 (IQR 0.5-6.5) days. No patient died from the procedure. Neither pneumothorax nor severe bleeding occurred in any of the patients. Five of the 13 patients experienced moderate bleeding, and all bleeding events were successfully controlled with prophylactic balloon blockers. Pathological diagnosis by TBLC was obtained in all patients, and the diagnosis of diffuse alveolar damage was made in nine of them.

Conclusions: In patients with VV-ECMO support, the TBLC procedure is generally safe when standardised bleeding prophylaxis is in place. TBLC contributes to identifying underlying aetiologies in patients with acute hypoxaemic respiratory failure of unknown aetiology.

Conflict of interest statement

Conflict of interest: All the authors state that there are no conflicts of interest related to this study.

Copyright ©The authors 2022.

Figures

FIGURE 1
FIGURE 1
The standardised process for transbronchial lung cryobiopsy (TBLC) in veno-venous extracorporeal membrane oxygenation (VV-ECMO)-supported patients. ACT: activated clotting time; ACS: acute coronary syndrome; AD: aortic dissection; APE: acute pulmonary embolism: aPTT: prothrombin time; FIO2: inspiratory oxygen fraction; GIB: gastrointestinal bleeding; PEEP: positive end-expiratory pressure; PH: pulmonary hypertension; PT: prothrombin time; RP-EBUS: radial probe endobronchial ultrasound; UFH: unfractionated heparin.

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Source: PubMed

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