Bronchoscopy-guided intervention therapy with extracorporeal membrane oxygenation support for advanced cancer metastasis to the central airway: A case report
| Autor: | Jun-Mei Ma, Wei Yu, Keling Chen, Wenjun Tang, Qianming Xia, Pengcheng Zhou |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty bronchoscopy Esophageal Neoplasms severe airway stenosis medicine.medical_treatment malignant tumor Argon plasma coagulation Diagnosis Differential 03 medical and health sciences 0302 clinical medicine Bronchoscopy medicine Extracorporeal membrane oxygenation Humans 030212 general & internal medicine Clinical Case Report Neoplasm Metastasis Farmers Respiratory distress medicine.diagnostic_test business.industry General Medicine interventional therapy Esophageal cancer respiratory system Middle Aged extracorporeal membrane oxygenation medicine.disease Surgery Radiation therapy Airway Obstruction Stenosis 030220 oncology & carcinogenesis Carcinoma Squamous Cell Tracheal Neoplasms business Airway Tomography X-Ray Computed Research Article |
| Zdroj: | Medicine |
| ISSN: | 1536-5964 |
| Popis: | Introduction: Dyspnea due to tracheal invasion by malignant tumors is a common oncological emergency that is difficult to manage, and a common cause of death among patients with advanced cancer. Bronchoscopy-guided intervention therapy under conventional ventilation is very risky for patients with severe central airway stenosis. Extracorporeal membrane oxygenation (ECMO) provides strong cardiopulmonary support, but is rarely used in bronchoscopy-guided interventional therapy. Patient concerns: The patient had advanced esophageal cancer with metastases to the trachea and left and right main bronchi. Despite several sessions of radiotherapy, chemotherapy, and bronchoscopy-guided intervention therapy, the tumor in the airway became enlarged, the lumen was severely narrow, and the patient experienced respiratory distress. Diagnosis: A thoracic computed tomography scan performed at our hospital revealed invasion of the trachea and opening of the left and right main bronchi by the esophageal cancer, blockage of the stent by the tumor, and severe luminal narrowing. An emergency bronchoscopy showed slit-like stenosis of the middle and lower part of the trachea and the left and right main bronchi, and the tumor was highly vascular. Interventions: To reduce the risk of major airway bleeding and asphyxia during bronchoscopy under conventional ventilation, we finally performed argon plasma coagulation with a high frequency electric knife and cryotherapy with ECMO support. Outcomes: We successfully cleared the tumor tissue in the airway under ECMO support. The trachea and left and right main bronchi recovered smoothly, and the patient was soon discharged. Conclusion: ECMO can meet the oxygenation needs during bronchoscopy-guided intervention therapy. For patients with severe central airway obstruction due to malignant tumors, ECMO should be considered if conventional respiratory support cannot guarantee the safety of surgery. |
| Databáze: | OpenAIRE |
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