DOI: 10.1097/01.ccm.0000475023.82101.18
,
Issn Print: 0090-3493
Publication Date: 2015/12/01
1192: OXYGENATION VIA BI-VENTRICULAR ASSIST DEVICE FOR EMERGENCY AIRWAY MANAGEMENT
Samuel Howitt; Sarah Stirling; Piotr Krysiak; Bryce Pate; Marc Maybauer
Excerpt
Case Report: We describe the emergency insertion of an oxygenator into a patient’s biventricular assist device (BiVAD) circuit during an airway emergency. A fifty six year old man treated with a BiVAD for cardiogenic shock was noted to be bleeding from a mucosal tear on the left pallatoglossal pillar. The oropharynx was packed to promote hemostasis and bleeding seemed to settle. However, twelve hr later the patient’s tracheostomy tube blocked suddenly. The mouth and nose remained packed with bloodstained gauze but we were able to ventilate with difficulty through the tracheostomy tube using a Mapleson C circuit noting markedly limited exhalation. Fiber optic bronchoscopy via the tracheostomy revealed a large blood clot at the end of the tube. The scope was maneuvered past the clot and ventilation became easier. Distal to the blockage the airway was clear; no bleeding source was identified. A passage through the clot was cleared using suction catheters and grasper devices but the clot quickly reformed. A size 6.0 cuffed Endotracheal Tube (ETT) was loaded onto an intubating fiber optic scope, passed through the tracheostomy tube, past the clot and positioned just above the carina. Our perfusionist then inserted an oxygenator into the BiVAD circuit creating a VenoArterial-ECMO configuration providing an alternative source of gas exchange in case of recurrent airway obstruction and to allow definitive treatment to the bleeding point. While oxygenating the patient via VenoArterial-ECMO, bleeding from the traumatized palatoglossal pillar and the tracheostomy site was treated with bipolar diathermy and copious clots were removed from the oropharynx, subglottis and the esophagus. The tracheostomy tube was replaced and the size 6.0 ETT was removed. In this group of patients who are at high risk of hemorrhagic airway complications, the ability to provide gas exchange via an oxygenator in the event of an airway emergency is invaluable. Our unit now considers early insertion of an oxygenator into the circuits of all patients receiving MCS who show signs of airway bleeding.
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