Surgical Treatment of Intractable Secondary Pneumothorax Under ECMO Support in a Patient with Interstitial Pneumonia

Abstract

A 66-year-old woman diagnosed as having unclassifiable idiopathic interstitial pneumonia and receiving treatment as an outpatient was urgently hospitalized for left-sided tension pneumothorax. Since the bronchopulmonary fistula failed to close despite repeated attempts at pleurodesis with several chemical substances and endobronchial occlusions, surgical treatment was scheduled. To avoid a risk of developing pneumothorax on the contralateral side as well under positive pressure ventilation and the difficulty in keeping adequate ventilation, we decided to perform the surgery under extracorporeal membrane oxygenation (ECMO) support, after holding thorough discussions about its introduction and management with the staff of the concerned departments. At the time of the operation, veno-arterial ECMO was first established at the angiography laboratory. Then, the patient was wheeled to the operation room, where video-assisted bullectomy was performed with the patient placed in the right semi-lateral decubitus position. The ECMO could be withdrawn immediately after the operation. The chest drainage tube was removed on the third postoperative day. In patients receiving surgical treatment for intractable secondary pneumothorax, it is a challenge to manage the cardiopulmonary condition in the perioperative period. To perform the relatively uncommon operation smoothly and safely under ECMO support, we need thorough discussions beforehand with the staff of the concerned departments.