To the Editor:
Cryotherapy has become an important aspect of pediatric interventional
bronchoscopy. Through application of the Joule-Thompson effect,
cryotherapy utilizes freeze-thaw cycles via rapid expansion of
pressurized gas [1]. Bronchoscopic cryoextraction (i.e. using
cryotherapy to remove material en bloc from the airway) has shown
promise for the removal of large mucus plugs, obstructive thrombi, and
foreign bodies in children [2, 3]. Although there are no reports of
serious complications related to cryoextraction in children, the risk of
hemorrhage is likely enhanced in coagulopathic patients, including those
receiving anticoagulation for extracorporeal membrane oxygenation (ECMO)
support. Because the bronchoscope and cryoprobe must be removed in
tandem to extricate foreign material, there is a period of time when
visualization of the airway is lost. As such, the ability to quickly
address complications is hampered.
Sriprasart et al. described a 2-bronchoscope approach in adults
undergoing cryobiopsy for undiagnosed interstitial lung disease (ILD)
[4]. By utilizing an additional bronchoscope with a patent
suction/instrumentation channel, this approach minimized time outside of
the patient’s airway and facilitated prompt hemostasis following lung
tissue removal. In this report, which we believe to be the first of its
kind, we describe a similar technique performed in a pediatric patient
undergoing cryoextraction of a massive airway thrombus secondary to
prolonged ECMO support.