title: Flexible Bronchoscopy Is Safe and Effective in Adult Subjects Supported With Extracorporeal Membrane Oxygenation.
abstract: BACKGROUND
  Previous studies have demonstrated the safety of flexible bronchoscopy (FB) in mechanically ventilated subjects. However, the safety of FB in adult subjects receiving extracorporeal membrane oxygenation (ECMO) has not been described previously.
  
  
  METHODS
  A retrospective review was conducted of all adult subjects who underwent FB while receiving ECMO support at the University of Alabama at Birmingham Hospital from January 1, 2013, to December 31, 2014. Physiologic variables, pre- and post-FB ECMO, and ventilator settings were recorded.
  
  
  RESULTS
  79 adult subjects underwent FB receiving ECMO with a total of 223 bronchoscopies. The most common indications for bronchoscopy included diagnostic evaluation of infection in subjects with pneumonia (29%) and clearance of excessive secretions (22%). In 70% of subjects, moderate or greater amounts of secretions were noted. FB yielded positive culture data in 37 subjects (47%), which resulted in a change to the antibiotic regimen in 14 subjects (38%) with positive culture data. No significant differences in mean PaO2 /FIO2 , mean ECMO flow, mean sweep gas, ventilator settings, or hemodynamic parameters (heart rate, oxygen saturation, and mean blood pressure) were noted before and after FB. Complications were mild and transient: blood-tinged secretions after FB in 21% cases, which resolved spontaneously, intraprocedural hypoxemia in 2.2% of cases, and dysrhythmia in <1% of cases. There were no episodes of ECMO cannula dislodgement or inadvertent extubation.
  
  
  CONCLUSIONS
  FB can be used safely in adult subjects supported with ECMO and is not associated with significant hemodynamics changes, bleeding, or mechanical complications during ECMO support.
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Nirmal S
authors.initials: NS
authors.lastname: Sharma
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Timothy
authors.initials: T
authors.lastname: Peters
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Tejaswini
authors.initials: T
authors.lastname: Kulkarni
authors.affiliation: Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Hoopes
authors.affiliation: Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Bellot
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Wille
authors.affiliation: Division of Pulmonary and Critical Care Medicine diaze@uab.edu.
authors.forename: Enrique
authors.initials: E
authors.lastname: Diaz-Guzman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: ARDS; ECMO; bronchoscopy; cardiorespiratory failure; veno-arterial ECMO; veno-venous ECMO