• Omar Daoud, Pascal Augustin, Pierre Mordant, Sigismond Lasocki, Nawwar Al-Attar, Jean-Michel Maury, Mathieu Desmard, Dan Longrois, and Philippe Montravers.
• Department of Anesthesiology and Surgical Intensive Care Unit, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Université Paris, Paris, France.
• Ann. Thorac. Surg. 2011 Jul 1;92(1):327-30.

PurposeThe management of bronchial fistula associated with acute lung injury raises two major concerns: (1) high ventilation pressures are necessary for lung recruitment but detrimental for fistula healing, and (2) adequate lung recruitment is prevented by large air leak. Primary surgical closure of bronchial fistula should be attempted but is rarely successful during mechanical ventilation. We sought to evaluate the efficacy of extracorporeal membrane oxygenation associated with lung-protective ventilation in case of failure of conventional management.DescriptionArteriovenous extracorporeal membrane oxygenation was initiated by femorofemoral cannulation. A stepwise increase of extracorporeal membrane oxygenation output and a decrease of mechanical ventilation settings were simultaneously performed, aiming at lung-protective ventilation.EvaluationDuring a 1-year period, this protocol management was used in 5 patients with refractory respiratory failure associated with bronchial fistula after thoracic operations. This strategy allowed fistula healing in 3 patients.ConclusionsIf correctly timed, extracorporeal membrane oxygenation can provide a therapeutic bridge to lung-protective ventilation and allow bronchial fistula healing in case of refractory respiratory failure.Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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