Clapp Nicole, Wu Huimin, Marburger Erin, Sheikh Ghias, Chaudry Fawad
College of Medicine, University of Oklahoma Health Sciences Center, 73104, USA.
Pulmonary, Critical Care & Sleep Medicine Section, College of Medicine, University of Oklahoma Health Sciences Center, 73104, USA.
Respir Med Case Rep. 2022 Jul 31;39:101718. doi: 10.1016/j.rmcr.2022.101718. eCollection 2022.
Extracorporeal membrane oxygenation (ECMO) is an artificial lung or heart used to oxygenate and circulate blood. Veno-venous ECMO is most commonly used as an emergency therapy in patients with acute respiratory distress syndrome (ARDS), but it has the potential to be useful in other respiratory-related diseases. We report a case where ECMO successfully allowed for interventional pulmonary procedures in a patient with life-threatening tracheal obstruction secondary to lung cancer, requiring tumor debulking and silicone Y stent placement. The patient was a 44-year-old male who was admitted to the intensive care unit (ICU) for an advanced stage subcarinal tumor invading into the trachea and bilateral main stem bronchi. The tumor was unresectable, and the first attempt to debulk the tumor was terminated due to the risk of complete airway occlusion. With the help of ECMO, the second attempt at tumor debulking was successful, and a Y stent was placed. The patient regained ventilation in both lungs and was transferred out of the ICU on day 2 post-op. The pathology confirmed squamous cell carcinoma, programmed death-ligand 1 (PD-L1) 99%. The patient received immunotherapy after hospital discharge. ECMO has the potential to be useful for patients with severe tracheal obstructions and compromised respiratory systems. For patients with certain types of lung cancer, who are good candidates for novel immunotherapies and targeted therapies, it offers a potential bridging therapy for procedures that would otherwise be too dangerous and should be considered when traditional treatments for these patients fail.
体外膜肺氧合（ECMO）是一种用于为血液充氧和循环的人工肺或心脏。静脉 - 静脉ECMO最常用于急性呼吸窘迫综合征（ARDS）患者的紧急治疗，但它也有可能用于其他与呼吸相关的疾病。我们报告了一例病例，在该病例中，ECMO成功地使一名因肺癌导致危及生命的气管阻塞、需要进行肿瘤减瘤和放置硅胶Y形支架的患者能够接受介入性肺部手术。该患者为44岁男性，因晚期隆突下肿瘤侵犯气管和双侧主支气管而入住重症监护病房（ICU）。肿瘤无法切除，首次肿瘤减瘤尝试因有完全气道阻塞的风险而终止。在ECMO的帮助下，第二次肿瘤减瘤尝试成功，并放置了Y形支架。患者双肺恢复通气，术后第2天转出ICU。病理证实为鳞状细胞癌，程序性死亡配体1（PD - L1）为99%。患者出院后接受了免疫治疗。ECMO对于患有严重气管阻塞和呼吸系统受损的患者可能有用。对于某些类型的肺癌患者，他们是新型免疫疗法和靶向疗法的良好候选者，ECMO为那些否则会过于危险的手术提供了一种潜在的桥接治疗，当这些患者的传统治疗失败时应予以考虑。
