C79-13 Creative Utilization of ECMO to Overcome an Unusual Diagnostic Challenge

Abstract We present the case of a 72 year old male with past medical history of COPD, CAD s/p PCI to left main artery, HFpEF, and squamous cell lung cancer s/p left lower lobe lobectomy in 2003, and complete pneumonectomy in 2011, who presented to our hospital for ongoing shortness of breath on exertion and at rest. He mentioned that his dyspnea had been getting worse over the past few months, and had been noticing a functional decline in his daily activities. EMR review had shown that our patient had been admitted several times during the past year for dyspnea on exertion and had been treated on the lines of COPD exacerbation. He also required multiple rounds of steroids during the year outside of hospitalizations for possible COPD exacerbations due to his ongoing symptoms. Pulmonary team was involved in his care after CT scan of the chest was concerning for possible retained secretions in the trachea. On close review, the finding in question seemed to be occupying nearly 2/3rd of the tracheal lumen. This needed to be evaluated by bronchoscopy ASAP, however due to uncertainty of diagnosis, and history of pneumonectomy, there were significant concerns for intra-procedural morbidity and mortality, especially if interventions were to be offered. A multi-disciplinary meeting was held, in which it was the consensus of the group that malignancy recurrence was high on the list of differentials, and that intervention such as Argon Plasma Coagulation should be performed if a lesion is seen during bronchoscopy. The group had also decided that the best course of action would be to initiate V-V ECMO prior to the procedure in order to overcome the risk of morbidity and mortality associate with the procedure. The patient was cannulated on the morning of the bronchoscopy, and was subsequently taken to the OR for bronchoscopy, which showed large lesion in the tracheal lumen with near complete occlusion of the trachea. Argon plasma coagulation was performed for tumor debulking. The patient was then admitted to MICU for monitoring, and was successfully decannulated afterwards. The patient further underwent chemoradiation therapy and is currently on immunotherapy with Durvalumab. This case presented an unusual diagnostic challenge due to history of pneumonectomy and tracheal mass, with high risk of intra-procedural morbidity. We present this case for V-V ECMO as a means to overcome difficulties posed in diagnostics and therapeutic interventions given patient’s history. This abstract is funded by: none