A case of broncho-cutaneous fistula secondary to tuberculosis successfully managed with awake veno-venous extracorporeal membrane oxygenation

Genex Correa; Daniel Taylor; Dominik Vogel; Duncan Wyncoll

doi:10.1016/j.rmcr.2021.101351

A case of broncho-cutaneous fistula secondary to tuberculosis successfully managed with awake veno-venous extracorporeal membrane oxygenation

Respir Med Case Rep. 2021 Jan 19:32:101351. doi: 10.1016/j.rmcr.2021.101351. eCollection 2021.

Authors

Genex Correa¹, Daniel Taylor¹, Dominik Vogel¹, Duncan Wyncoll¹

Affiliation

¹ Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.

Abstract

A broncho-cutaneous fistula (BCF) is a communicating tract between the bronchus and the cutaneous surface of the thoracic wall and can be the primary presenting sign of several disease processes. It has been associated with positive pressure ventilation (PPV), post pneumonectomy, thoracostomy tubes, perforating chest trauma, neoplasia and chronic empyema. We report a case of a 45-year-old immunocompetent man presenting with severe hypercapnic respiratory failure secondary to a BCF as a result of tuberculosis (TB)-related empyema necessitans. Veno-venous extracorporeal membrane oxygenation (VV ECMO) was employed during spontaneous breathing to mitigate the risks of PPV, to facilitate diagnostics and enable targeted treatment. Awake VV ECMO is an effective supportive therapy for complex, destructive lung pathologies with a known reversible aetiology in which PPV would be potentially detrimental.

Keywords: Awake ECMO; Broncho-cutaneous fistula (BCF); Extra corporeal membrane oxygenation (ECMO); Positive pressure ventilation (PPV); Tuberculosis (TB).

Publication types

Case Reports