Flexible and Rigid Bronchoscopy for Critically Ill Children on Extracorporeal Membrane Oxygenation

Ashley Young; Krupa Patel; Kiona Allen; Saied Ghadersohi; Matthew Rowland; Inbal Hazkani

doi:10.1002/lary.31460

Flexible and Rigid Bronchoscopy for Critically Ill Children on Extracorporeal Membrane Oxygenation

Laryngoscope. 2024 Apr 23. doi: 10.1002/lary.31460. Online ahead of print.

Authors

Ashley Young¹, Krupa Patel^{1

2}, Kiona Allen^{1

3}, Saied Ghadersohi^{1

2}, Matthew Rowland^{1

4

5}, Inbal Hazkani^{1

2}

Affiliations

¹ Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A.
² Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.
³ Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.
⁴ Department of Anesthesiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.
⁵ Division of Critical Care, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.

PMID: 38651446
DOI: 10.1002/lary.31460

Abstract

Background: We aim to describe our experience with bronchoscopy to diagnose and relieve tracheobronchial obstruction in anticipation of decannulation in children on extracorporeal membrane oxygenation (ECMO) support.

Methods: A retrospective cohort study of children on ECMO between 1/2018 and 12/2022.

Results: A total of 107 children required ECMO support during the study period for cardiac (n = 48, 45%), pulmonary (n = 38, 36%), or cardiopulmonary dysfunction (n = 21, 20%). Thirty-seven (35%) patients underwent 99 bronchoscopies while on ECMO. Most (76%, n = 75) experienced no improvement or worsening of chest radiography 24 hours following bronchoscopy. Clinical improvement in tidal volumes 48 hours after the first bronchoscopy was noted in 13/25 patients with available data (p = 0.05). Adverse events were seen in 18 (49%) patients who underwent bronchoscopy, including pneumothorax (n = 8, 22%), pneumonia (n = 7, 19%), pulmonary hemorrhage (n = 6, 16%), and sepsis (n = 5, 14%). ECMO courses were longer (25.4 ± 37.2 vs 6.1 ± 8.8 days, p < 0.0001) and more likely to be complicated by pneumonia (p = 0.0004) and sepsis (p = 0.047) in patients who underwent bronchoscopy compared with those who did not. Adverse events following bronchoscopy were associated with the number of bronchoscopies (p = 0.0003) and the presence of obstructive materials but not with the type of bronchoscopy or indication for ECMO. Mortality rates were similar between patients who underwent bronchoscopy and those who did not.

Conclusion: Children requiring bronchoscopy represent a subset of the sickest children on ECMO. Bronchoscopy may provide benefit in children with persistent cardiopulmonary failure who could not otherwise be decannulated. Adverse events are associated with the number of bronchoscopies and the presence of obstructive material.

Level of evidence: 4 Laryngoscope, 2024.

Keywords: adverse events; bronchial casts; bronchoscopy; extracorporeal membrane oxygenation; flexible; pediatric; pulmonary hemorrhage; rigid.