Journal of Developmental Medicine(Electronic Version)  2019, Vol. 7 Issue (2): 151-155,160 DOI: 10.3969/j.issn.2095-5340.2019.02.015 |
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| Application of extracorporeal membrane oxygenation support for undergoing flexible bronchoscopy interventional therapy in children |
| ZHU Bin, XU Xuan, ZHANG Xiao-juan, WANG Meng, LAN Ying, SHEN Xiao-li
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| Pediatric Intensive Care Unit, The Seventh Medical Center, General Hospital of PLA, Beijing 100700,China) |
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Abstract 【Abstract】 Objective To preliminary explore the clinical application and experience of extracorporeal
membrane oxygenation (ECMO)-supported underwent bronchoscope interventional therapy through a case
with foreign bodies in trachea were removed by a ?exible bronchoscope with ECMO supporting. Methods
The infant was female with one year and two months, who was treated as pneumonia at other hospital. On
January 01, 2018 the infant had a cough suddenly, and received the invasive respiratory support (invasive
ventilator mainly) at the local hospital due to chest CT showed foreign bodies in trachea possiblely, but the child still had persistent hypoxemia and ?uctuating heart rate. On January 06, 2018 the child was received
the ECMO therapy and was transferred to that hospital by the ECMO group of The Seventh Medical
Center, General Hospital of PLA . With the support of ECMO, tracheal intubation was pulled out and the
foreign bodies were removed by nasopharyngeal soft bronchoscope. Results The transshipment team
installed V-A ECMO equipment at local hospital, initial ?ow was 0.7 L/min, the ratio of oxygen ?ow to
blood ?ow was 1:1, FiO2 was 60%. After 30 min, arterial blood gas showed: PaO2 rose from 35 mmHg
(1 mmHg=0.133 kPa) to 160 mmHg, PCO2 dropped from 76 mmHg to 45 mmHg and blood lactic acid
(Lac) dropped from 3.5 mmol/L to 0.9 mmol/L. The child was transferred to the pediatric intensive care
unit of hospital after 6 h with stable condition, tracheal intubation was extracted with ECMO support and
foreign bodies were removed via nasopharyngeal soft bronchoscope. During operation whose heart rate
and transcutaneous oxygen saturation were stable. 30 min after surgery, PaO2 was 202 mmHg, PaCO2 was 44 mmHg and Lac was 1.5 mmoL/L. The ?ow rate of ECMO was adjusted to 0.5 L/min and the FiO2 was adjusted to 50%. The heart rate of the case ranged from 100-110 beats per min, PaO2 maintained at 150-200 mmHg. During the use of ECMO, the heart function of the infant was significantly improved, and
pulmonary in?ammation was absorbed gradually by chest X-ray. After using ECMO for 72 h, the ?ow rate
was reduced to 0.3 /min, FiO2 was reduced to 30%, and arterial blood gas showed: PaO2 was 190mmHg,
PaCO2 was 36mmHg, SaO2 was 100%, and Lac was 0.9 mmol/L. The ECMO was removed at post-
operation for 90 h and the child was discharged after 2 weeks. The case got better for treating as bleeding
and oozing after undergoing ECMO. Conclusion ECMO can effectively gain time for bronchoscopic
interventional therapy and improve its methods of application and maintain vital signs during treatment.
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Received: 16 November 2018
Published: 10 May 2019
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