title: Extracorporeal Lung Support as a Bridge to Diagnosis of Pulmonary Tumor Embolism.
abstract: Bridging to diagnosis is an emerging technique used in end-stage cardiorespiratory failure that prolongs a patient's life using various modalities of extracorporeal lung support (ECLS) to achieve antemortem diagnosis. Pulmonary tumor embolism occurs when cell clusters travel from primary malignancies through venous circulation to the lungs, causing respiratory failure through inflammatory and venoocclusive pathways. Due to its nonspecific symptomatology, pulmonary tumor embolism remains an elusive diagnosis antemortem. Herein, we bridge a patient who presented in acute respiratory failure to the diagnosis of pulmonary tumor embolism from a gastric signet-ring cell carcinoma using ECLS modalities including venoarterial extracorporeal membrane oxygenation and centrally cannulated Novalung pumpless extracorporeal lung assist. We demonstrate the utility of this approach in diagnostically uncertain cases in unstable patients who are potentially acceptable ECLS and transplant candidates.
authors.affiliation: Department of Surgery, University of Alberta, Edmonton, AB, Canada; Mazankowski Alberta Heart Institute, Edmonton, AB, Canada.
authors.forename: Vishnu
authors.identifier: 0000-0002-5803-7995
authors.initials: V
authors.lastname: Vasanthan
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, AB, Canada; University of Alberta Hospital, Edmonton, AB, Canada.
authors.forename: Kieran
authors.initials: K
authors.lastname: Halloran
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, AB, Canada; University of Alberta Hospital, Edmonton, AB, Canada.
authors.forename: Lakshmi
authors.identifier: 0000-0002-0840-9041
authors.initials: L
authors.lastname: Puttagunta
authors.affiliation: Department of Surgery, University of Alberta, Edmonton, AB, Canada; Mazankowski Alberta Heart Institute, Edmonton, AB, Canada.
authors.forename: Jayan
authors.identifier: 0000-0001-5827-9823
authors.initials: J
authors.lastname: Nagendran