Flexible bronchoscopy for children on extracorporeal membrane oxygenation for cardiac failure*

OBJECTIVE: To describe the safety and use of flexible bronchoscopy in the management of respiratory complications in patients on extracorporeal membrane oxygenation for cardiac failure. DESIGN: Retrospective cohort study. SETTING: Pediatric intensive care unit at a tertiary care university hospital. PATIENTS: Patients requiring extracorporeal membrane oxygenation for cardiac failure in the pediatric intensive care unit between 2003 and 2008. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Forty-eight patients required extracorporeal membrane oxygenation for cardiac failure (32 after surgery for congenital heart disease, 16 for acquired heart disease) during the study period. Seven patients (15%) underwent 17 flexible bronchoscopies. Median age and weight at extracorporeal membrane oxygenation cannulation was 10 days (range, 4 days to 27 yrs) and 3.2 kg (range, 2.8-66 kg), respectively. Median duration of extracorporeal membrane oxygenation in this group was longer than those not undergoing flexible bronchoscopy (314 vs. 114 hrs, p < .001). In all cases, flexible bronchoscopy indication was persistent atelectasis despite conventional ventilator adjustments. Activated clotting time during flexible bronchoscopy was maintained between 180 and 220 secs (normal, 80-150 secs) in all patients. No major complications occurred. A minor complication occurred in one of 17 flexible bronchoscopies (6%), scant oozing that stopped with epinephrine lavage. Findings included bronchus compression or narrowing in four patients and mucous plugging in three patients. Bronchoalveolar lavage specimens identified new ventilator-associated infections in three patients. In two patients with mucous plugging, serial bronchoscopies were accompanied by stepwise decreases in extracorporeal membrane oxygenation flow, thereby facilitating discontinuation from extracorporeal membrane oxygenation support. CONCLUSIONS: In patients requiring extracorporeal membrane oxygenation for cardiac failure, flexible bronchoscopy can be performed safely, provide important diagnostic information to the bedside clinician, and, perhaps, therapeutic benefit to the patient.