Delayed tracheoesophageal fistula and refractory respiratory failure caused by inhalation burns and emergency venovenous ECMO to facilitate its management: a case report.
Jayesh A DhananiJason PincusShane TownsendGeorge PangElizabeth VujcichMorgan WindsorMichael Charles ReadePublished in: Journal of burn care & research : official publication of the American Burn Association (2023)
Acquired tracheoesophageal fistulae are uncommon in burn patients but can occur as a complication of inhalation injury. We report a case of a 30-year-old male patient presenting after suffering from inhalation and 25% total body surface area burns. On post burns day 14 he developed a massive tracheoesophageal fistula causing refractory acute respiratory failure. Veno-venous extracorporeal membrane (VV ECMO) oxygenation was initiated without systemic anticoagulation via bi-femoral cannulation under transthoracic echocardiography guidance. He underwent successful 5-hour apnoeic ventilation-assisted surgical repair of the fistula via a right posterolateral thoracotomy. ECMO was discontinued after 36 hours, and he was discharged to the ward after 33 days in the intensive care unit. Inhalation burn injury can cause a delayed life-threatening tracheoesophageal fistula. Surgical repair can be successfully performed for this condition. VV- ECMO can be used to facilitate prolonged apnoeic surgery and to manage refractory respiratory failure due to this condition.
Keyphrases
- respiratory failure
- extracorporeal membrane oxygenation
- acute respiratory distress syndrome
- mechanical ventilation
- end stage renal disease
- ejection fraction
- newly diagnosed
- minimally invasive
- emergency department
- case report
- public health
- blood pressure
- computed tomography
- left ventricular
- pulmonary hypertension
- healthcare
- atrial fibrillation
- coronary artery bypass
- intensive care unit
- wound healing
- percutaneous coronary intervention
- drug induced