0
Critical Care |

Venoarterial Extracorporeal Membrane Oxygenation (ECMO) for Support During Whole Lung Lavage for Pulmonary Alveolar Proteinosis

Julie Monteagudo*, MD; Nicholas Cavaricchi, MD; Boyd Hehn, MD; Naveed Hasan, MD; Hitoshi Hirose, MD
Author and Funding Information

Thomas Jefferson University Hospital, Philadelphia, PA


Chest. 2012;142(4_MeetingAbstracts):342A. doi:10.1378/chest.1389135
Text Size: A A A
Published online

Abstract

SESSION TYPE: Critical Care Student/Resident Case Report Posters II

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: ECMO as support during whole lung lavage (WLL) for pulmonary alveolar proteinosis is reserved for severe cases where oxygenation is inadequate to support the patient using the ventilator alone. While most publications describe a venovenous cannulation with variable results we present a successful case using venoarterial cannulation and discuss the potential benefits of this mode of ECMO support.

CASE PRESENTATION: We present the case of a 44 year old female with a past medical history of Behcets disease and a BMI of 37 who was diagnosed with pulmonary alveolar proteinosis (PAP) on a lung biopsy after presenting with dyspnea. As her supplemental oxygen needs escalated she was intubated and was difficult to oxygenate on a conventional ventilator. She was urgently taken to the operating room for venoarterial ECMO support and whole lung lavage. The patient was cannulated femorally using a 20 french venous catheter and an 18 french arterial catheter, with a retrograde arterial catheter to preserve distal perfusion to the right lower extremity. ECMO flow was satisfactory at 4L/min. The whole lung lavage was performed bilaterally using 12 liters of normal saline in one liter instillations with chest physiotherapy between liters. The character and color of the fluid was initially opaque and sero-sanguinous; at the conclusion of the 12 liter lavage the fluid was serous and transparent. Her oxygenation improved immediately post operatively and she was decannulated from ECMO on the fifth post-operative day without complications.

DISCUSSION: We propose that venoarterial ECMO is superior to venovenous ECMO during whole lung lavage because total cardiopulmonary support can be provided to the patient to maintain adequate oxygenation and hemodynamics. During whole lung lavage while the pulmonary vascular resistance increases, strain on the right ventricle increases and can be avoided with venoarterial ECMO.

CONCLUSIONS: Venoarterial ECMO for support during whole lung lavage for PAP may provide a superior alternative to venovenous ECMO in patients who are difficult to ventilate and/or oxygenate due to the severity of their disease.

1) Cohen ES, Elpern E, Silver MR. Pulmonary alveolar proteinosis causing severe hypoxemic respiratory failure treated with sequential whole-lung lavage utilizing venovenous extracorporeal membrane oxygenation: a case report and review. Chest. 2001 Sep;120(3):1024-6.

2) Centella T, Oliva E, Andrade IG, Epeldegui A. The use of a membrane oxygenator with extracorporeal circulation in bronchoalveolar lavage for alveolar proteinosis. Interact Cardiovasc Thorac Surg. 2005 Oct;4(5):447-9. Epub 2005 Jun 27.

3) Rogers RM, Szidon JP, Shelburne J, Neigh JL, Shuman JF, Tantum KR. Hemodynamic response of the pulmonary circulation to bronchopulmonary lavage in man. N Engl J Med. 1972 Jun 8;286(23):1230-3.

DISCLOSURE: The following authors have nothing to disclose: Julie Monteagudo, NIcholas Cavaricchi, Boyd Hehn, Naveed Hasan, Hitoshi Hirose

No Product/Research Disclosure Information

Thomas Jefferson University Hospital, Philadelphia, PA

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543