Original article
General thoracic
Multidisciplinary Management of Life-Threatening Massive Hemoptysis: A 10-Year Experience

https://doi.org/10.1016/j.athoracsur.2008.11.010Get rights and content

Background

Life-threatening massive hemoptysis requires prompt action and thoracic surgical input. Although there are a number of reports regarding each therapeutic modality for medical or surgical treatment, the significance of a multidisciplinary strategy remains undetermined.

Methods

From January 1995 to December 2005, 120 patients were referred to our cardiothoracic center with massive hemoptysis. We retrospectively reviewed and compared the outcomes of a recent 5-year period (2000 to 2005) with those from the previous 5 years (1995 to 1999), as we made major changes in our practice in 2000. We currently try to avoid surgery within 48 hours after onset of active hemoptysis and adopt bronchial artery embolization as a first-line therapy. Treatment decisions are made after discussions among intensive care unit physicians, thoracic surgeons, and interventional radiologists.

Results

The former group had 49 patients (57.9 ± 14.1 years old, 41 males), and the recent group, 71 (62.2 ± 23.5 years old, 52 males). There were no significant differences for any characteristics studied between the groups. In analyses of short-term complications after surgery, the former had a higher in-hospital mortality rate than the recent group (15% versus 0%). Furthermore, postoperative complications were seen in 8 patients (30%) in the former, whereas those occurred in 3 patients (18%) in the recent group.

Conclusion

Bronchial artery embolization is an effective therapeutic tool and plays a pivotal role in management of life-threatening massive hemoptysis. Surgery is indicated when bronchial artery embolization is not suitable and can be safely performed in combination with a rigid bronchoscopy or bronchial artery embolization procedure. Our results indicate that a multidisciplinary approach should be adopted for management of life-threatening massive hemoptysis.

Section snippets

Selection of Patients and Management

From January 1995 to December 2005, 120 patients (93 males; mean age, 60.3 years; range, 16 to 89 years) were admitted to our emergency center with life-threatening massive hemoptysis. At our institution, life-threatening massive hemoptysis is defined as the expectoration of 600 mL or more of blood over the course of 24 hours, and all patients included in this study satisfied that criterion. To compare the contemporary outcomes with previous years, the patients were divided into two groups

Characteristics of Patients Who Underwent Bronchial Artery Embolization and Outcomes From 2000 to 2005

Of the 120 patients who were admitted to our center with life-threatening massive hemoptysis between January of 1995 and December of 2005, the recent group (2000 to 2005) had 71 patients. Of the 71 patients in whom conservative treatment failed, 62 (52 males, 10 females; mean age, 58.4 years; range, 32 to 89 years) underwent a bronchial arteriography examination, which showed that the cause of the massive hemoptysis was old tuberculosis in 34, bronchiectasis in 14, mycetoma in 5, lung cancer in

Comment

The recent emergence of BAE as a therapeutic modality for life-threatening massive hemoptysis has revolutionized management of the disease, as it is a less invasive but reliable procedure that leads to excellent therapeutic outcomes [6, 7, 8]. Nevertheless, surgical management of massive hemoptysis still plays an important role as a therapeutic strategy. A number of studies have addressed the management of massive hemoptysis by focusing on a single treatment modality, such as BAE or pulmonary

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