Published online Sep 26, 2020. doi: 10.12998/wjcc.v8.i18.4245
Peer-review started: April 13, 2020
First decision: July 25, 2020
Revised: July 31, 2020
Accepted: August 15, 2020
Article in press: August 15, 2020
Published online: September 26, 2020
Massive pulmonary haemorrhage can spoil the entire lung and block the airway in a short period of time due to severe bleeding, which quickly leads to death. Alveolar lavage is an effective method for haemostasis and airway maintenance. However, patients often cannot tolerate alveolar lavage due to severe hypoxia. We used extracorporeal membrane oxygenation (ECMO) to overcome this limitation in a patient with massive pulmonary haemorrhage due to severe trauma and succeeded in saving the life by repeated alveolar lavage.
A 22-year-old man sustained multiple injuries in a motor vehicle accident and was transferred to our emergency department. On admission, he had a slight cough and a small amount of bloody sputum; computed tomography revealed multiple fractures and mild pulmonary contusion. At 37 h after admission, he developed severe chest tightness, chest pain, dizziness and haemoptysis. His oxygen saturation was 68%. Emergency endotracheal intubation was performed, and a large amount of bloody sputum was suctioned. After transfer to the intensive care unit, he developed refractory hypoxemia and heparin-free venovenous ECMO was initiated. Fibreoptic bronchoscopy revealed diffuse and profuse blood in all bronchopulmonary segment. Bleeding was observed in the trachea and right bronchus, and repeated alveolar lavage was performed. On day 3, the patient’s haemoptysis ceased, and ECMO support was terminated 10 d later. Tracheostomy was performed on day 15, and the patient was weaned from the ventilator on day 21.
Alveolar lavage combined with ECMO can control bleeding in trauma-induced massive pulmonary haemorrhage, is safe and can be performed bedside.
Core Tip: Massive pulmonary haemorrhage due to trauma is a rare but life-threatening form of pulmonary contusion. In this work, we report a patient who presented with progressive massive pulmonary haemorrhage that was successfully treated with repeated alveolar lavage combined with extracorporeal membrane oxygenation. Our study indicates the efficacy of a novel option for the treatment of massive pulmonary haemorrhage. Moreover, we discuss the medication regimen of alveolar lavage and the management of heparin-free extracorporeal membrane oxygenation.