Extracorporeal Membrane Oxygenation Combined With Esophageal Pressure-Guided Mechanical Ventilation as Salvage Therapies in Postpneumonectomy Acute Respiratory Distress Syndrome

AI Summary

Venovenous extracorporeal membrane oxygenation enabled life saving left pneumonectomy for refractory bleeding in a patient with massive hemoptysis and ARDS.
Oesophageal pressure guided ventilation permitted safe adjustment of ventilator settings for right lung ARDS with total airway closure and high elastance.
Combined VV ECMO and oesophageal pressure monitoring facilitated weaning from ECMO by postoperative day 16 and subsequent ICU discharge; tumour pathology showed atypical carcinoid.

Crit Care Explor. 2026 May 5;8(5):e1398. doi: 10.1097/CCE.0000000000001398. eCollection 2026 May 1.

ABSTRACT

BACKGROUND: Massive hemoptysis and postpneumonectomy acute respiratory distress syndrome (ARDS) are rare but life-threatening conditions with limited therapeutic options. This case highlights the feasibility of combining venovenous extracorporeal membrane oxygenation (VV-ECMO) with esophageal pressure-guided ventilation to support both surgical and respiratory management in a critically ill patient.

CASE SUMMARY: A 67-year-old woman developed massive hemoptysis after bronchoscopic biopsy of a left hilar lung mass. Despite bronchial artery embolization and selective right lung ventilation, severe ARDS ensued. A salvage left pneumonectomy was performed under VV-ECMO due to refractory bleeding. Postoperatively, the patient developed right-lung ARDS with total airway closure and high elastance. Esophageal pressure monitoring enabled safe adjustment of ventilator settings. She was weaned from ECMO on postoperative day 16 and later discharged from ICU. Final pathology confirmed an atypical carcinoid tumor with negative margins.

CONCLUSION: VV-ECMO can enable life-saving pneumonectomy in select patients. Esophageal pressure monitoring may optimize ventilation in postpneumonectomy ARDS with severe mechanical impairment.

PMID:42084216 | DOI:10.1097/CCE.0000000000001398

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