57: Ultra–Prolonged VV-ECMO (120+ Days) for End-Stage Bronchiectasis with Recurrent Airway Hemorrhage: A Case Report of Survival”

Background: Ultra–Prolonged VV-ECMO (120+ Days) for End-Stage Bronchiectasis with Recurrent Airway Hemorrhage: A Case Report of Survival” bronchiectasis complicated by recurrent pneumonia and respiratory failure remains a major management challenge. Patients with advanced disease are frequently dependent on high-flow oxygen or mechanical ventilation and may require extracorporeal membrane oxygenation (ECMO) as a bridge to recovery or transplant. Prolonged ECMO support beyond 60–90 days is uncommon and is usually associated with high morbidity, particularly when complicated by life-threatening airway hemorrhage. Case Presentation: We report a 42-year-old female with severe bilateral bronchiectasis with surgical removal of 2/3 of the lt lunging childhood admitted with community-acquired pneumonia and septic shock. She developed acute on chronic hypercapnic respiratory failure with refractory acidosis necessitating VV-ECMO support. The clinical course was complicated by massive tracheostomy bleeding requiring repeated bronchoscopic tamponade, transfusion support, and temporary ECMO flow escalation to maintain oxygenation during airway interventions. Despite multiple infectious exacerbations, ECMO circuit exchanges, and prolonged rehabilitation challenges, she remained hemodynamically stable and neurologically intact. Intervention: VV-ECMO was maintained for approximately 4 months as a bridging strategy while allowing maximal lung-protective ventilation, airway stabilization, and nutritional optimization. A multidisciplinary team — including ECMO specialists, interventional pulmonology, ENT surgery, thoracic surgery, and transplant coordination — guided care. Aggressive secretion clearance, tailored antimicrobial therapy based on serial cultures, and bleeding-source control were key to stabilization. Outcome: After 4 months of ECMO support, The patient transitioned to non-invasive ventilatory support with preserved neurological function and quality of life, for ongoing reassessment for lung transplant candidacy. Conclusion: This case highlights the feasibility of long-term VV-ECMO (>120 days) as a bridge to recovery in selected bronchiectasis patients despite severe complications such as recurrent major airway hemorrhage. Multidisciplinary care, aggressive airway management, and individualized weaning strategies are crucial for survival in this complex population.