PMID- 37113528
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230430
IS  - 1178-6973 (Print)
IS  - 1178-6973 (Electronic)
IS  - 1178-6973 (Linking)
VI  - 16
DP  - 2023
TI  - Massive Airway Hemorrhage in Severe COVID-19 and the Role of Endotracheal Tube 
      Clamping.
PG  - 2387-2393
LID - 10.2147/IDR.S378408 [doi]
AB  - BACKGROUND: Venovenous extracorporeal membrane oxygenation (VV-ECMO) has been 
      widely used in treating patients with coronavirus disease 2019 (COVID-19) with 
      severe respiratory failure. However, there are few reports of the successful 
      treatment of patients with massive airway hemorrhage in severe COVID-19 during 
      VV-ECMO treatment. METHODS: We analyzed the treatment process of a patient with a 
      massive airway hemorrhage in severe COVID-19, who underwent prolonged VV-ECMO 
      treatment. RESULTS: A 59-year-old female patient was admitted to the intensive 
      care unit after being confirmed to have severe acute respiratory syndrome 
      coronavirus 2 infection with severe acute respiratory distress syndrome. VV-ECMO, 
      mechanical ventilation, and prone ventilation were administered. Major airway 
      hemorrhage occurred on day 14 of ECMO treatment; conventional management was 
      ineffective. We provided complete VV-ECMO support, discontinued anticoagulation, 
      disconnected the ventilator, clipped the tracheal intubation, and intervened to 
      embolize the descending bronchial arteries. After the airway hemorrhage stopped, 
      we administered cryotherapy under bronchoscopy, low-dose urokinase locally, and 
      bronchoalveolar lavage in the airway to clear the blood clots. The patient's 
      condition gradually improved; she underwent ECMO weaning and decannulation after 
      88 days of VV-ECMO treatment, and the membrane oxygenator was changed out four 
      times. She was successfully discharged after 182 days in hospital. CONCLUSION: 
      Massive airway hemorrhage in patients with severe COVID-19 and treated with ECMO 
      is catastrophic. It is feasible to clamp the tracheal tube with the full support 
      of ECMO. Notably, bronchoscopy with cryotherapy is effective for removing blood 
      clots.
CI  - (c) 2023 Guo et al.
FAU - Guo, Litao
AU  - Guo L
AUID- ORCID: 0000-0002-6611-0902
AD  - Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an 
      Jiaotong University, Xi'an, People's Republic of China.
FAU - Liu, Yu
AU  - Liu Y
AD  - Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an 
      Jiaotong University, Xi'an, People's Republic of China.
FAU - Zhang, Lei
AU  - Zhang L
AD  - Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an 
      Jiaotong University, Xi'an, People's Republic of China.
FAU - Li, Qing
AU  - Li Q
AD  - Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, 
      Southeast University, Nanjing, People's Republic of China.
FAU - Qiu, Haibo
AU  - Qiu H
AD  - Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, 
      Southeast University, Nanjing, People's Republic of China.
FAU - Guo, Yaling
AU  - Guo Y
AD  - Department of Infectious Diseases, Xi'an Eighth Hospital, Xi'an, People's 
      Republic of China.
FAU - Shi, Qindong
AU  - Shi Q
AD  - Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an 
      Jiaotong University, Xi'an, People's Republic of China.
LA  - eng
PT  - Case Reports
DEP - 20230421
PL  - New Zealand
TA  - Infect Drug Resist
JT  - Infection and drug resistance
JID - 101550216
PMC - PMC10128077
OTO - NOTNLM
OT  - acute respiratory distress syndrome
OT  - airway hemorrhage
OT  - coronavirus disease 2019
OT  - cryotherapy
OT  - extracorporeal membrane oxygenation
OT  - mechanical ventilation
COIS- The authors report no conflicts of interest in this work.
EDAT- 2023/04/28 06:42
MHDA- 2023/04/28 06:43
PMCR- 2023/04/21
CRDT- 2023/04/28 02:29
PHST- 2023/01/26 00:00 [received]
PHST- 2023/04/14 00:00 [accepted]
PHST- 2023/04/28 06:43 [medline]
PHST- 2023/04/28 06:42 [pubmed]
PHST- 2023/04/28 02:29 [entrez]
PHST- 2023/04/21 00:00 [pmc-release]
AID - 378408 [pii]
AID - 10.2147/IDR.S378408 [doi]
PST - epublish
SO  - Infect Drug Resist. 2023 Apr 21;16:2387-2393. doi: 10.2147/IDR.S378408. 
      eCollection 2023.