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.