Trauma pneumonectomy followed by extracorporeal membrane oxygenation cannulation: a case report

Abstract

Background: Trauma pneumonectomy remains an incredibly morbid procedure, reserved for the most critical cases where it is the only surgical option to stop massive ongoing hemorrhage. There are only few cases reported in the literature of survivors of trauma pneumonectomy complicated by acute respiratory distress syndrome (ARDS). We present our case of long-term survival in this circumstance. Given the limited published research on survival after prolonged veno-venous extracorporeal membrane oxygenation (VV-ECMO), it is important to share our experiences using VV-ECMO as an adjunct for pulmonary recovery.

Case description: We present a case of a 35-year-old male patient who survived a gunshot wound to the right lung following trauma pneumonectomy with the assistance of VV-ECMO. He developed postoperative hemodynamic instability and required 38 days of VV-ECMO. He ultimately survived discharge from the hospital. One year after his gunshot injury, the patient was living at home with assistance. Urgent VV-ECMO cannulation and a multi-disciplinary approach was lifesaving in the treatment of this patient's post-pneumonectomy ARDS.

Conclusions: In review of the literature, ECMO has been used in a few other cases of ARDS following trauma pneumonectomy to allow for full pulmonary recovery. This case highlights the challenges following this morbid procedure, however with a multidisciplinary approach and urgent use of ECMO, a favorable outcome can be achieved.

Keywords: Pneumonectomy; acute respiratory distress system; case report; multidisciplinary care; veno-venous extracorporeal membrane oxygenation (VV ECMO).

Figure 1

Chest X-ray on arrival to trauma bay immediately following gunshot wound to right chest (A) and post-operative day 2 demonstrating acute respiratory distress syndrome in the remaining left lung (B).

Figure 2

Patient clinical course timeline. GSW, gunshot wound; ED, emergency department; OR, operating room; POD, post-operative day; ECMO, extracorporeal membrane oxygenation.