Patient Case
An 11-year-old female with a recent diagnosis of acute myeloid leukemia
developed respiratory failure following chemotherapy induction.
Progression of her respiratory failure led to initiation of
venous-venous ECMO (VV-ECMO) and concomitant anticoagulation. While on
VV-ECMO, the patient developed recurrent, consolidative opacifications
on chest imaging consistent with large airway obstruction. Over the
course of 3 weeks, the patient underwent 8 therapeutic bronchoscopies to
remove mucus plugs and large endobronchial thrombi. Several approaches
(including standard suctioning, saline lavage, and alligator forceps)
were trialed with decreasing benefit. Ultimately, radiography
demonstrated complete opacification of the thorax [Figure 1A], and
flexible bronchoscopy revealed thrombus extending upwards into the ETT
[Figure 1C]. Otolaryngology was consulted, however, the patient’s
tenuous status precluded endotracheal tube (ETT) removal and rigid
bronchoscopy. At that time, the decision was made to attempt thrombus
removal via cryoextraction.