14: Combined VV-ECMO and Independent Lung Ventilation for Hydatid Cyst: A Case Report

Introduction: Hydatid cysts can present in a single lung. Intensivists aim toward preventing further spilling of content to the other lung to maintain adequate oxygenation and ventilation, and prevent secondary damage until definitive surgical management can be provided, including pneumonectomy/lobectomy. This strategy presents a challenge to intensivists as different lungs have different compliance and driving pressure requiring different ventilator settings. ECMO can overcome this issue by directly delivering oxygen to the circulation bypassing the capillary-alveolar membrane. Case Presentation: A 21-year-old female patient of Arabic origin known as asthmatic presented with complaints of shortness of breath and cough for 10 days. Her initial chest x-ray was highly suspicious of a hydatid cyst (Figure 1). Due to her rapid deterioration respiratory-wise, she was intubated and mechanically ventilated four days following her ICU admission, then supported by VV ECMO a day later. Chest surgeons were involved in her management and they confirmed the diagnosis of the Hydatid cyst. On the second day of ECMO, we proceeded to independent lung ventilation in order to protect the left lung. She underwent a right middle lobectomy while on ECMO and gradually showed substantial improvement in ventilator parameters and chest x-ray (Figure 2). Unfortunately, as we planned her weaning and extubation, she started to deteriorate again, and the bronchoscopy showed accumulated blood clots in the right lung and leakage of pathological tissue to the left lung. Eventually, she succumbed to her illness and died 45 days postoperatively. Conclusion: ECMO can be useful tool where independent lung ventilation is needed. This was the case in our patient, who initially improved by applying an independent lung ventilation strategy. However, this strategy can be used as a bridge until definitive management of the pathological lung is achieved. Independent lung ventilation and ECMO may temporarily be beneficial in managing single lung pathology until definitive management of the pathology is achieved.