Table 2.

Management of BPA complications

Treating vascular injury

1. Immediate balloon tamponade of the injured pulmonary artery.

2. Cessation/reversal of anticoagulation.

3. Repeat prolonged balloon tamponade as necessary.

4. Bailout transcatheter coil embolization, covered stent implantation, and/or gelatin/adipose injection for persistent pulmonary hemorrhage.

Supporting respiratory function

1. Oropharyngeal suctioning, supplemental oxygen, noninvasive positive pressure ventilation.

2. Consider mechanical ventilation and ECMO in ongoing respiratory failure.

Avoiding cardiopulmonary collapse

1. Immediate control of bleeding (above).

2. Support of both respiratory and circulatory function (as both may be compromised at baseline).

3. Mechanical intubation when noninvasive positive pressure ventilation provides insufficient oxygenation or pneumatic suppression of pulmonary hemorrhage.

4. Lateral decubitus positioning toward the impaired lung and selective intubation of the contralateral lung for unilateral airway compromise.

5. Chest tube insertion, fluids, blood transfusion for tension hemothorax.

6. Rescue ECMO support for ongoing respiratory and circulatory failure (for patient stabilization, bridge to emergent surgical/nonsurgical interventions, and cardiopulmonary recovery).

BPA, balloon pulmonary angioplasty; ECMO, extracorporeal membranous oxygenation.