Repair of traumatic avulsion of the right bronchus in children using extracorporeal membrane oxygenation support

Extracorporeal membrane oxygenation (ECMO)-assisted surgery for traumatic bronchial rupture: a report of three cases

Background

Traumatic tracheal rupture is a severe closed chest injury that often causes major respiratory and circulatory disturbances requiring emergency surgery. We have found that veno-venous extracorporeal membrane oxygenation (VV-ECMO) employs lung-protective ventilation strategies to facilitate lung rest, aiming to minimize the risk of ventilator-induced lung injury, while ensuring adequate oxygenation.

Case Description

We presented 3 critically ill patients who presented with traumatic bronchial rupture between 2019 and 2021, and underwent emergency thoracic surgery with the help of VV-ECMO. The ECMO support time, the operative time, the duration of postoperative hospital stay, and the postoperative mechanical ventilation time were collected in this study. All patients were successfully treated and discharged home. The duration of surgery ranged from 135 to 180 min, the duration of ECMO use ranged from 98 to 123 h, the duration of postoperative ventilator use ranged from 5 to 8 days, and the duration of postoperative hospital stay ranged from 14 to 30 days. All 3 patients had good postoperative pulmonary re-expansion, with no residual tracheal or bronchial stenosis, and good physical activity following the surgery.

Conclusions

We reported successful use of VV-ECMO in critically ill patients with traumatic bronchial rupture presenting in acute respiratory and circulatory failure. Performing emergency surgery with ECMO-assisted support can provide more time to stabilize the patient and ensure the safety of the procedure. However, considering the small sample size of this study, larger cohorts with long-term follow-up data are needed to further evaluate its application.

Intraoperative Extracorporeal Membrane Oxygenation Rescue of a Polytrauma Patient With a Complete Right Mainstem Bronchus Avulsion: A Pediatric Case Report

In pediatric patients experiencing blunt chest trauma, tracheobronchial avulsion injuries are rare but frequently fatal. We report the case of a 13-year-old boy who presented to our trauma center following a semitruck versus pedestrian collision. During his operative course, he developed refractory hypoxemia requiring emergency venovenous (VV) extracorporeal membrane oxygenation (ECMO) support. After stabilization, a complete right mainstem bronchus avulsion was identified and treated.