Bellvitge Hospital performs total lung lavage with ECMO support to treat a very rare and serious respiratory disease

Alveolar proteinosis is a very rare respiratory disease (it has an approximate prevalence of 3.7 cases per million inhabitants) caused by the accumulation of lipoprotein material in the pulmonary alveolus that causes respiratory difficulties (dyspnea), a dry cough and a low oxygen level in the blood (hypoxemia or even respiratory failure). The disease appears in healthy people between 30 and 50 years of age, and the most proven treatment is total pulmonary or bronchoalveolar lavage with saline solution, which is usually carried out in hospital ICUs.

This treatment was not viable, however, in the case of a patient transferred from Tarragona with severe respiratory failure caused by alveolar proteinosis, complicated by an infection. It was then that the Intensive Care Medicine and Pulmonology departments used ECMO (extracorporeal membrane oxygenation system) for the first time at the Hospital de Bellvitge as a solution to allow total lung lavage. "The venovenous ECMO made it possible to oxygenate the patient and then we were able to perform the lavage, first of one lung and then the other, in a process that requires 30 liters of physiological saline and two days to complete," explains Dr. M. Paz Fuset, from the Intensive Medicine Service of the Bellvitge Hospital.

The patient had the added circumstance of being in such a serious situation that the only alternative was that he could improve in order to receive a lung transplant. "For the first time at Bellvitge hospital, support with ECMO has been used for this treatment, in a very rare pathology and with a patient who was in a borderline situation; without ECMO we would not have been able to do the lavage and it would not have arrived to transplantation, "says Dr. Rosa López, from the Bellvitge Hospital Pneumology Service. In fact, the process of washing the patient's lungs with the support of ECMO was carried out on two occasions between last October and January, which allowed him to arrive in good condition at the time of transplantation, which was performed at the end of last February. The two specialist doctors from the Hospital de Bellvitge underline the coordinated and multidisciplinary work between different teams at the center as key elements that have made it possible to attend to the patient with the appropriate treatment in a complex situation.

Bellvitge University Hospital has extensive experience in the use of ECMOs to support the lung and the heart. In fact, it is among the European health centers that have implanted more devices of this type in Covid-19 patients during the pandemic.