Infection and Drug Resistance (Apr 2023)
Massive Airway Hemorrhage in Severe COVID-19 and the Role of Endotracheal Tube Clamping
Abstract
Litao Guo,1 Yu Liu,1 Lei Zhang,1 Qing Li,2 Haibo Qiu,2 Yaling Guo,3 Qindong Shi1 1Department of Critical Care Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China; 2Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People’s Republic of China; 3Department of Infectious Diseases, Xi’an Eighth Hospital, Xi’an, People’s Republic of ChinaCorrespondence: Qindong Shi, Department of Critical Care Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 Road Yanta West, Xi’an, Shaanxi, 710061, People’s Republic of China, Tel +86 029 85323186, Email [email protected]: Venovenous extracorporeal membrane oxygenation (VV-ECMO) has been widely used in treating patients with coronavirus disease 2019 (COVID-19) with severe respiratory failure. However, there are few reports of the successful treatment of patients with massive airway hemorrhage in severe COVID-19 during VV-ECMO treatment.Methods: We analyzed the treatment process of a patient with a massive airway hemorrhage in severe COVID-19, who underwent prolonged VV-ECMO treatment.Results: A 59-year-old female patient was admitted to the intensive care unit after being confirmed to have severe acute respiratory syndrome coronavirus 2 infection with severe acute respiratory distress syndrome. VV-ECMO, mechanical ventilation, and prone ventilation were administered. Major airway hemorrhage occurred on day 14 of ECMO treatment; conventional management was ineffective. We provided complete VV-ECMO support, discontinued anticoagulation, disconnected the ventilator, clipped the tracheal intubation, and intervened to embolize the descending bronchial arteries. After the airway hemorrhage stopped, we administered cryotherapy under bronchoscopy, low-dose urokinase locally, and bronchoalveolar lavage in the airway to clear the blood clots. The patient’s condition gradually improved; she underwent ECMO weaning and decannulation after 88 days of VV-ECMO treatment, and the membrane oxygenator was changed out four times. She was successfully discharged after 182 days in hospital.Conclusion: Massive airway hemorrhage in patients with severe COVID-19 and treated with ECMO is catastrophic. It is feasible to clamp the tracheal tube with the full support of ECMO. Notably, bronchoscopy with cryotherapy is effective for removing blood clots.Keywords: coronavirus disease 2019, acute respiratory distress syndrome, mechanical ventilation, cryotherapy, airway hemorrhage, extracorporeal membrane oxygenation
