Transbronchial Lung Cryobiopsy (TBLC) in an Acute Respiratory Distress Syndrome (ARDS) Patient Under Extracorporeal Membrane Oxygenation (ECMO)

We report one of the first known cases of transbronchial lung cryobiopsy (TBLC) performed in a patient with severe acute respiratory distress syndrome (ARDS) receiving extracorporeal membrane oxygenation (ECMO). After transient stopping of anticoagulation, TBLCs were performed in a controlled environment at the bedside in the intensive care unit (ICU). The ECMO avoided severe oxygenation deterioration, and bleeding was controlled by Fogarty balloon inflation. No major complications occurred, and the pulmonary biopsies helped obtain prognostic information and decide the most appropriate management. Nevertheless, the safety of this technique in such high-risk patients should be further investigated in larger case series, as it can be harmful if not performed in an appropriate environment.