The use of a membrane oxygenator with extracorporeal circulation in bronchoalveolar lavage for alveolar proteinosis

Abstract

Alveolar proteinosis is a rare pulmonary disease, characterised by the accumulation of a proteinaceous material in the alveoli, which severely reduces gas exchange and causes progressive disability of the patient, usually moderate, but sometimes completely disabling. Whole-lung lavage (WLL) is the preferred technique for the treatment of this disease, and it is performed by introducing into the lungs and draining a fluid (saline), which removes the phospholipidic material present in the alveoli, offering the patient a marked improvement in a short period of time. Sometimes the whole-lung lavage technique is not well tolerated by the patient, requiring the support of a membrane oxygenator during the course of the procedure. Few successful cases have been published. We report the case of a 33-year-old man with severe hypoxaemia who suffered cardiopulmonary arrest after the first attempt of bronchoalveolar lavage (BAL) and required support by means of extracorporeal venovenous circulation with a membrane oxygenator (ECMO). An initial incomplete lavage was performed with ECMO support, but the patient was re-admitted 7 months later and we performed a second WLL of both lungs in the same session, again using ECMO. Also, the BAL technique and its association with ECMO when necessary are reviewed.