ABSTRACT
Objective: To evaluate the benefit of thoracic computed tomography (CT) and flexible fibreoptic bronchoscopy (FFB) on ECMO in a paediatric case series. Methods: Retrospective review of all children on ECMO during years 2018-2020 who underwent both CT and FFB at Evelina London. Centre policy is to undertake CT chest for all respiratory patients using inspiratory and expiratory phases with angiography. FFB is performed for patient specific concerns. Results: Of 51 patients receiving ECMO, 10 patients (19.6%) underwent both procedures and one had angiography instead of CT. Eight patients were supported on VV-ECMO, three on VA-ECMO. 26 FFB were performed in 11 patients (range 1-5 per patient). FFB cleared the airway from mucous plugs in three patients after phased CT showed significant areas of dynamic air trapping, including one patient with COVID-19 pneumonia. FFB was used in three patients with pulmonary haemorrhage: it enabled packing of the trachea in one patient who received coiled embolization of the pulmonary artery (PA) and granted extensive airway lavage (vasculitis in first patient and post Glenn procedure for hypoplastic left heart syndrome in second). CT confirmed the diagnosis in two patients, the third patient required angiography demonstrating collaterals subsequently coiled. CT with FFB identified PA narrowing and contralateral main bronchus compression post cardiac repair, guiding the ventilation strategy. FFB was used to place a nasal endotracheal tube in a patient with difficult airway whose existing tracheostomy site was infected. CT wasn't beneficial in this patient. Pulmonary embolism on CT was identified in one patient guiding increased anticoagulation strategy. FFB and CT excluded traumatic injuries in a newborn with respiratory failure and pneumomediastinum. Conclusions: Both FFB and CT gave a clear therapeutic benefit in 10/11 patients on ECMO with complementary diagnostic information.