Airway spray cryotherapy: Initial outcomes from a multiinstitutional registry

David J. Finley, Joe Dycoco, Saiyad Sarkar, William S. Krimsky, John T. Sherwood, Dominic Dekeratry, Gordon Downie, Joel Atwood, Hiran C. Fernando, Valerie W. Rusch

Research output: Contribution to journalArticle

Abstract

Background: Spray cryotherapy (SCT) uses a noncontact system to deliver liquid nitrogen (2 to 4 psi) through an endoscopic catheter. Rapid freezing and thawing of tissue causes cellular death and is also hemostatic. We report the preliminary results from 6 institutions in which SCT was used for the treatment of malignant airway tumors. Methods: SCT was performed on patients with symptomatic airway tumors and reviewed retrospectively. Airway narrowing was graded as 25% or smaller, 26% to 50%, 51% to 75%, and exceeding 75%. All events were documented and assessed. Results: Eighty patients (45 male [56%]) underwent 114 treatments. Median age was 66 years (range, 15 to 90 years). All patients were treated with minimal blood loss. Fifty-eight percent of the cases were outpatient procedures. Airway obstruction exceeded 75% in most of the lesions treated. There were 21 intraoperative events (19%), including hypotension, bradycardia and tachycardia, ST segment changes, desaturation, and an airway tear. Three pneumothoraces occurred, one requiring emergency chest tube placement. Two intraoperative deaths were associated with bradycardia. Three postoperative deaths occurred in patients who were transitioned to comfort care. All but 1 patient had airway patency after treatment. Conclusions: SCT can be used in patients with highly vascular tumors, with reduced bleeding complications and a low overall complication rate. Caution is needed before SCT is used on a widespread basis, given the intraoperative complications. Although the potential benefit of SCT is considerable, this needs to be confirmed in larger studies.

Original languageEnglish (US)
Pages (from-to)199-204
Number of pages6
JournalAnnals of Thoracic Surgery
Volume94
Issue number1
DOIs
StatePublished - Jul 2012
Externally publishedYes

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Cryotherapy
Registries
Bradycardia
Chest Tubes
Neoplasms
Intraoperative Complications
Pneumothorax
Hemostatics
Airway Obstruction
Tears
Tachycardia
Hypotension
Freezing
Blood Vessels
Cause of Death
Emergencies
Outpatients
Nitrogen
Therapeutics
Catheters

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Finley, D. J., Dycoco, J., Sarkar, S., Krimsky, W. S., Sherwood, J. T., Dekeratry, D., ... Rusch, V. W. (2012). Airway spray cryotherapy: Initial outcomes from a multiinstitutional registry. Annals of Thoracic Surgery, 94(1), 199-204. https://doi.org/10.1016/j.athoracsur.2012.01.112

Airway spray cryotherapy : Initial outcomes from a multiinstitutional registry. / Finley, David J.; Dycoco, Joe; Sarkar, Saiyad; Krimsky, William S.; Sherwood, John T.; Dekeratry, Dominic; Downie, Gordon; Atwood, Joel; Fernando, Hiran C.; Rusch, Valerie W.

In: Annals of Thoracic Surgery, Vol. 94, No. 1, 07.2012, p. 199-204.

Research output: Contribution to journalArticle

Finley, DJ, Dycoco, J, Sarkar, S, Krimsky, WS, Sherwood, JT, Dekeratry, D, Downie, G, Atwood, J, Fernando, HC & Rusch, VW 2012, 'Airway spray cryotherapy: Initial outcomes from a multiinstitutional registry', Annals of Thoracic Surgery, vol. 94, no. 1, pp. 199-204. https://doi.org/10.1016/j.athoracsur.2012.01.112
Finley DJ, Dycoco J, Sarkar S, Krimsky WS, Sherwood JT, Dekeratry D et al. Airway spray cryotherapy: Initial outcomes from a multiinstitutional registry. Annals of Thoracic Surgery. 2012 Jul;94(1):199-204. https://doi.org/10.1016/j.athoracsur.2012.01.112
Finley, David J. ; Dycoco, Joe ; Sarkar, Saiyad ; Krimsky, William S. ; Sherwood, John T. ; Dekeratry, Dominic ; Downie, Gordon ; Atwood, Joel ; Fernando, Hiran C. ; Rusch, Valerie W. / Airway spray cryotherapy : Initial outcomes from a multiinstitutional registry. In: Annals of Thoracic Surgery. 2012 ; Vol. 94, No. 1. pp. 199-204.
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