Endotracheal tube clamping and extracorporeal membrane oxygenation to resuscitate massive pulmonary haemorrhage

Abstract

Massive pulmonary haemorrhage is a life-threatening and difficult-to-manage condition. In certain circumstances, traditional approaches for haemoptysis may not be effective. Here, we report a 64-year-old man presenting with dyspnoea and leg oedema. He was diagnosed with microscopic polyangiitis due to positive perinuclear anti-neutrophil cyto-plasmic antibody and other supportive evidence. His hospital course was complicated with massive pulmonary haemorrhage, which led to hypoxic respiratory failure, shock, and pulseless electrical activity. Extracorporeal membrane oxygenation (ECMO) was employed during cardiopulmonary resuscitation. To control blood loss from his lungs, we clamped the endotracheal tube for tamponade therapy. The tube was clamped for 15 h till the haemorrhage subsided. ECMO and ventilator support were successfully weaned off after 5 and 10 days, respectively. Our favourable experience suggests that endotracheal tube clamping with ECMO support is a viable management option for life-threatening pulmonary haemorrhage.