Endobronchial Balloon Tamponade using a Fogarty catheter

in Max Super Speciality Hospital, Dehradun

Apr 18 , 2023

Haemoptysis is a medical emergency and needs urgent intervention. If not managed, the outcome can be catastrophic. Even if the patient stabilises post-bleed, the clots need to be evacuated to prevent secondary collapse or infection in the lung and also to decrease the oxygen requirement of the patient. Massive haemoptysis may even require emergency thoracotomy or BAE, which cannot be oered to a critical patient.

Here is an interesting case that was performed with the support from Dr. Mudit Garg, Associate Director, Neurosciences, Dr. Nikhil and the NSICU team. A 36-year-old polytrauma patient with CT signs of bilateral collapse consolidation and active haemoptysis came to the hospital. The patient had an active bleed and not maintaining saturation despite 100% FI O2 ventilation. The patient was reviewed and planned for a high-risk urgent bronchoscopy. Huge clots were retrieved with piece-meal approach, cleaning the major airway.

Followed by step-by-step evaluation of the site of the bleed, which, based on the CXR, seemed to be the right lung. Meanwhile, the right upper lobe and middle lobe were cleaned, and bronchial washings were taken for the closed segments. Eventually, the site of the bleed was found in the right lower lobe anterior segment – medial subsegment. The patient started bleeding torrentially again and occluded the entire right main bronchus. Despite multiple aliquots of cold saline and xylocaine-adrenaline, haemostasis was not possible; eventually, a 5F Fogarty balloon was taken from CTVS and introduced in the right lower lobe, aected subsegment inflated for 30 sec - 45 sec - 90 sec and 120 seconds respectively. After 4 - sittings with gaps in between, haemostasis was eventually achieved. The ooze stopped, and the patient was now hemodynamically stable. After the resolution of neuro issues planned extubation, the patient was finally discharged in stable condition.

The BAL taken also grew klebsiella, which was managed accordingly.

Bronchoscopy is a day-in and day-out procedure for pulmonologists, but with history of haemoptysis/torrential bleeds, the entire armamentarium and teamwork is more important. The use of a fogarty catheter here, was a life saver, else the patient would have collapsed, despite the airway was secured with an ET tube. Fogarty catheter is an indispensable tool for bronchoscopists and is a novel approach for haemoptysis by causing endobronchial tamponading.