• Respiratory care · Jun 2022

    Multicenter Study

    Flexible Bronchoscopy in Pediatric Venovenous Extracorporeal Membrane Oxygenation.

    • Elizabeth A Rosner, L ParkerJessicaJHelen DeVos Children's Hospital, Grand Rapids, Michigan., Caryn Vandenberg, Brian C Bridges, Todd J Kilbaugh, Melania M Bembea, Ranjit S Chima, Renee M Potera, Hitesh S Sandhu, Ryan P Barbaro, Keiko M Tarquinio, Ira M Cheifetz, and Matthew L Friedman.
    • Helen DeVos Children's Hospital, Grand Rapids, Michigan. Elizabeth.rosner@helendevoschildrens.org.
    • Respir Care. 2022 Jun 1; 67 (6): 688693688-693.

    BackgroundPediatric patients with ARDS will on occasion need venovenous extracorporeal membrane oxygenation (VV-ECMO) for organ support. As these patients recover, they may benefit from lung recruitment maneuvers including flexible bronchoscopy (FB). The objective of this study was to assess the clinical course of patients who underwent FB while on VV-ECMO for ARDS.MethodsThis was a secondary analysis of a retrospective multi-center cohort at 10 United States pediatric academic quaternary care centers. Data were collected on 204 subjects age 14 d-18 y on VV-ECMO.Results271 FBs were performed on 129 (63%) subjects. Pre-FB tidal volume was 1.8 mL/kg compared to 2.22 mL/kg following FB (P = .007). Dynamic compliance also improved from pre-FB to post-FB (2.23 vs 3.04 mL/cm H2O, P = .005). There was a low incidence of complications following FB (3.1%). Subjects in the FB group had fewer ECMO-free days (EFDs) (17.9 vs 22.1 d, P < .001), fewer ventilator-free days (VFDs) (40.0 vs 46.5 d, P = .001), and longer ICU length of stay (LOS) (18 vs 32 d, P < .001). Subjects in the early versus late FB group had more EFDs (19.4 vs 15.2 d, P = .003), more VFDs (43.0 vs 34.0 d, P = .004), and shorter ICU LOS (27.5 vs 35.5 d, P = .045). Mortality in the subjects who had at least one FB was 27.1% compared to 40% in the subjects who did not have a FB while on VV-ECMO (P = .057).ConclusionsFB can be performed on patients while anticoagulated on VV-ECMO with a low incidence of complications. FB may be beneficial especially when performed early in the course of VV-ECMO.Copyright © 2022 by Daedalus Enterprises.

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