Bronchoscopy-guided intervention therapy with extracorporeal membrane oxygenation support for advanced cancer metastasis to the central airway: A case report

• Published in: Medicine (Baltimore) 2020-03, Vol.99 (11), p.e19488-e19488
• Main Authors: Yu, Wei, Zhou, Pengcheng, Chen, Keling, Tang, Wenjun, Xia, Qianming, Ma, Junmei
• Format: Article
• Language: English
• Subjects: Airway Obstruction - etiology; Bronchoscopy; Carcinoma, Squamous Cell - complications; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - surgery; Clinical Case Report; Diagnosis, Differential; Esophageal Neoplasms - complications; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Extracorporeal Membrane Oxygenation; Farmers; Humans; Male; Middle Aged; Neoplasm Metastasis; Tomography, X-Ray Computed; Tracheal Neoplasms - complications; Tracheal Neoplasms - diagnostic imaging; Tracheal Neoplasms - secondary; Tracheal Neoplasms - surgery
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000019488

Dyspnea due to tracheal invasion by malignant tumors is a common oncological emergency that is difficult to manage, and a common cause of death among patients with advanced cancer. Bronchoscopy-guided intervention therapy under conventional ventilation is very risky for patients with severe central airway stenosis. Extracorporeal membrane oxygenation (ECMO) provides strong cardiopulmonary support, but is rarely used in bronchoscopy-guided interventional therapy. The patient had advanced esophageal cancer with metastases to the trachea and left and right main bronchi. Despite several sessions of radiotherapy, chemotherapy, and bronchoscopy-guided intervention therapy, the tumor in the airway became enlarged, the lumen was severely narrow, and the patient experienced respiratory distress. A thoracic computed tomography scan performed at our hospital revealed invasion of the trachea and opening of the left and right main bronchi by the esophageal cancer, blockage of the stent by the tumor, and severe luminal narrowing. An emergency bronchoscopy showed slit-like stenosis of the middle and lower part of the trachea and the left and right main bronchi, and the tumor was highly vascular. To reduce the risk of major airway bleeding and asphyxia during bronchoscopy under conventional ventilation, we finally performed argon plasma coagulation with a high frequency electric knife and cryotherapy with ECMO support. We successfully cleared the tumor tissue in the airway under ECMO support. The trachea and left and right main bronchi recovered smoothly, and the patient was soon discharged. ECMO can meet the oxygenation needs during bronchoscopy-guided intervention therapy. For patients with severe central airway obstruction due to malignant tumors, ECMO should be considered if conventional respiratory support cannot guarantee the safety of surgery.