CLINICAL APPLICATION OF ECMO FOR THE SAFETY OF MASSIVE BRONCHO-PULMONARY LAVAGE ON A PATIENT WITH SEVERE PULMONARY ALVEOLAR PROTEINOSIS

Abstract

This report demonstrates a favorable indication of veno-venous extracorporeal membrane oxygenation (v-v ECMO) during massive unilateral lung lavage on a patient suffering from severe hypoxemia due to pulmonary alveolar proteinosis (PAP). Biopsy specimen showed alveolar spaces containing PAS-stained material and contributed to the diagnosis of PAP. Lung lavage was attempted under general anesthesia with a conventional tracheal divider, but failed because of hypoxia during the procedure. The vascular access was achieved by percutaneous insertion of catheters into right atrium (RA) and superior caval vein (SVC). The ECMO system, composed of a centrifugal pump and two membrane oxygenators, maintained arterial blood oxygen tension at more than 70 torr during 225 minutes of v-v ECMO from RA to SVC with a flow rate of 3.1 L/min. Severe hypoxemia improved and this effect seemed to be long lasting. The v-v ECMO will be excellent life support means in the management of patient during broncho-pulmonary lavage for PAP.