Risk and relevance of open lung biopsy in pediatric ECMO patients: the Dutch experience

• Published in: Journal of pediatric surgery Vol. 52; no. 3; pp. 405 - 409
• Main Authors: Houmes, Robert Jan, ten Kate, Chantal A, Wildschut, Enno D, Verdijk, Rob M, Wijnen, René M.H, de Blaauw, Ivo, Tibboel, Dick, van Heijst, Arno F
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2017
• Subjects: Adolescent; Alveolar capillary dysplasia; Biopsy - adverse effects; Biopsy - methods; Biopsy - mortality; Child; Child, Preschool; Extracorporeal Membrane Oxygenation; Female; Hemorrhage - etiology; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases - pathology; Lung - pathology; Lung Diseases - etiology; Lung Diseases - pathology; Male; Misalignment of pulmonary veins; Netherlands; Newborn; Open lung biopsy; Pediatrics; Persistent Fetal Circulation Syndrome - pathology; Pulmonary Alveoli - abnormalities; Pulmonary Alveoli - pathology; Pulmonary hypertension; Pulmonary Veins - abnormalities; Risk; Surgery; Open lung biopsy; Alveolar capillary dysplasia; Extracorporeal membrane oxygenation; Newborn; Pulmonary hypertension; Misalignment of pulmonary veins
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2016.11.031

Abstract Background Open lung biopsy can help differentiate between reversible and irreversible lung disease and may guide therapy. To assess the risk–benefit ratio of this procedure in pediatric extracorporeal membrane oxygenation (ECMO) patients, we reviewed data of all patients who underwent an open lung biopsy during ECMO in one of the two pediatric ECMO centers in a nationwide study in the Netherlands. Results In nineteen neonatal and six pediatric patients (0–15.5 years), twenty-five open lung biopsies were performed during the study period. In 13 patients (52%), a classifying diagnosis of underlying lung disease could be made. In another nine patients (36%), specific pathological abnormalities were described. In three patients (12%), only nonspecific abnormalities were described. The histological results led to withdrawal of ECMO treatment in 6 neonates with alveolar capillary dysplasia/misalignment of pulmonary veins (24%) and in another 6 patients, corticosteroids were started (24%). All patients survived the biopsy procedure. Hemorrhagic complications were rare. Conclusion An open lung biopsy during an ECMO run in neonates and children is a safe procedure with a minimum risk for blood loss and biopsy-related death. It can be very useful in diagnosing the underlying pathology and can guide cessation of ECMO treatment and thereby avoid continuation of futile treatment, especially in neonatal patients. Level of evidence III. Type of study : Diagnostic study.