Extracorporeal membrane oxygenation during bronchopulmonary lavage
M. D. Altose, R. E. Hicks and M. W. Edwards Jr
Extracorporeal membrane oxygenation (ECMO) in a venoarterial perfusion
circuit was used to provide support of gas exchange during bronchopulmonary
lavage in a 32-year-old man with pulmonary alveolar proteinosis and severe
arterial hypoxemia. Prior to the lavage, Pao2 during mechanical ventilation
with 100% oxygen and positive end-expiratory pressure was only 125 mm Hg.
Extracorporeal perfusion at a flow rate of 3 liters/min, with oxygen
delivery of 244 ml/min, increased the Pao2 to 227 mmHg and lowered the mean
pulmonary artery pressure from 28 to 24 mm Hg. During bronchopulmonary
lavage and ECMO, the Pao2 ranged between 46 and 96 mm Hg. After the
procedure, pulmonary performance decidely improved. By reducing the chances
of fatal hypoxemia, ECMO allowed treatment to be instituted for this
potentially reversible disorder and proved helpful as a form of support
during the management of pulmonary alveolar proteinosis when severe
hypoxemia may have other wise precluded bronchopulmonary lavage.
