7: Flexible Fiberoptic Bronchoscopy is Beneficial in Children with Extracorporial Membrane Oxygenation Support

Introduction: Flexible fiberoptic bronchoscopy (FFB) has the potential to enhance diagnostic capabilities and improve pulmonary function in children on extracorporeal membrane oxygenation (ECMO). The objective of this study was to evaluate the benefits (clinical, radiological, and microbiological) of (FFB) and assess associated complications in children on ECMO Methods: We conducted a single-centre retrospective observational cohort study in a tertiary PICU. All FFB episodes performed during the study period on children aged 0 to 18 years on ECMO were included. Results: Out of the 155 children who received ECMO, 36 (23%) underwent a total of 92 episodes of FFB. FFB provided anatomical and pathological information in 53% (19/36) of cases and proved beneficial in clearing the airways in 62% (54/87) of the episodes. Overall, patients exhibited transient increases in ECMO and mechanical ventilation support one hour post-FFB in 14% (13/92) and 9.7% (9/92) episodes, respectively. At 6 hours, the mean FiO2 on the mechanical ventilator was lower (0.46 (±0.21) vs 0.53 (±0.21) p<0.01) with no change in mean airway pressure. Similarly, compared to pre-FFB, the FiO2 on ECMO was lower at 6 hours and 24 hours (0.65 (±0.25) vs 0.71 (±0.23) p<0.01 and 0.006 respectively) with no significant change in the sweep gas flow and ECMO flow. The radiological imaging indicated improved or stable findings in 91% (83/91) of FFB episodes. FFB contributed to the identification of new and previously unknown microbiological information in 75% (27/36) of the patients. The incidence of major complications was 7.6%. Minor self-resolving bleeding occurred in 25% (23/92) episodes, and major bleeding occurred in two episodes. Conclusions: FFB is a valuable adjunct in managing children with severe respiratory failure on ECMO, offering clinical benefits with a low rate of major complications.