Determine the efficacy of bronchial occlusion with pulmonary artery catheter (BOPAC) for the control of haemoptysis, and the factors associated with outcome.
All patients with haemoptysis managed with BOPAC admitted from October 1999 - December 2002 were categorised as massive and non-massive haemoptysis (cut-off point: 200ml). Data was gathered prospectively and logistic regression analysis was performed.
We included 48 patients: 35 (73%) male, 13 (27%) female, mean age 50 ± 17 (13–75) years, 37 (77%) with massive haemoptysis and 11 (23%) non-massive. Main cause was bronchiectasis (45% n-22) and the most frequent comorbidity condition diabetes. Chest x-ray showed abnormalities in the upper lobes in 87% (n-42) and bronchoscopy showed active bleeding in 100%. In the first 48 hours, 30 patients (63%) rebled and of them, 20 (67%) bled although the catheter was in a correct position, 9 (30%) presented rupture of the PAC and one (3%) had a misplaced PAC, remaining 37% of the complete group with complete success. Second bronchoscopy was done in 33 patients with 13 PAC replacements with absolute control of the haemorrhage in 46%. Active bleeding showed to be statistically significant with p<0.037 and OR 4.16 CI 95(1.134–15.289) in presence of comorbidity for rebleding. Mortality was 17% (n-8), 6 (12.5%) of them with massive haemoptysis and 2 (4.1%) nonmassive, 100% of the rebled group (association of p=0.018).CONCLUSIONS: The failure incidence within the first 48 hours was 63%. Active haemorrhage with bronchoscopy that needs BOPAC increases 4 times the risk of rebleeding as well as identifies risk of death.
BOPAC has high rebleeding risk and low efficacy for haemoptysis treatment. With a second attempt, efficacy diminishes so if active bleeding is found in bronchoscopy other techniques should be used.
D. Alcala, None.