FLEXIBLE FIBEROPTIC BRONCHOSCOPY IN CHILDREN ON EXTRACORPOREAL MEMBRANE-OXYGENATION

Bleeding is one of the most feared complications of veno-arterial (V-A ) extracorporeal membrane oxygenation (ECMO), and is also a potential complication of flexible fiberoptic bronchoscopy (FFB). We retrospecti vely reviewed 14 patients who underwent FFB procedures with bronchial washings (BW) and bronchoalveolar lavage (BAL) to evaluate the safety of this procedure in children on ECMO. Standard FFB with BAL/BW techni que was used after stabilization on ECMO. Three patients underwent two procedures each, and one patient underwent three, for a total of 19 p rocedures. No significant complications, such as bleeding have occurre d. Three patients required additional ECMO support shortly after FFB. After the 16 procedures done for atelectasis, seven patients improved radiographically, three had increased opacifications, and six were unc hanged. The remaining three patients had suspected pulmonary infection s, and in each, therapeutic decisions were guided by the BAL results. Lung compliance was unchanged or improved after 11 of 13 procedures. W e conclude that FFB with BAL/BW in children on ECMO is safe and may be nefit certain patients. (C) 1993 Wiley-Liss, Inc.