Venovenous extracorporeal membrane oxygenation support for treatment of bilateral spontaneous pneumothorax

Bilateral spontaneous pneumothorax is a rare but serious cause of respiratory distress. We treated a 77-year-old male with severe hypoxia caused by bilateral spontaneous pneumothorax using video-assisted thoracoscopic bullectomy assisted by a venovenous extracorporeal membrane oxygenation (ECMO) device. The patient came to the emergency department of our hospital with complaints of cough and dyspnea, and was hospitalized with right-side spontaneous pneumothorax and left-side pneumonia. After 12 days, a chest radiograph was performed to investigate persistent progressive shortness of breath at rest, which demonstrated contralateral pneumothorax. A chest tube was inserted into the left pleural cavity, and surgery was performed for bilateral pneumothorax by video-assisted thoracoscopic surgery (VATS) assisted by venovenous ECMO. Gas exchange was satisfactory throughout the surgical procedure and the postoperative course was uneventful without complications. Venovenous ECMO was effective for facilitation of VATS and reduced the risk of an intra-operative hypoxic condition.