Life-threatening Vesicular Bronchial Injury Requiring Veno-venous Extracorporeal Membrane Oxygenation Rescue in an Electronic Nicotine Delivery System User

The use of electronic nicotine delivery systems (ENDS) is increasing across the United States as tobacco bans increase and more people use these devices in an attempt to quit smoking. They are unregulated by the Food and Drug Administration, and there is significant concern that ENDS could produce several toxic byproducts. In this case a 35-year-old female presented to the emergency department with sudden-onset dyspnea. She denied current tobacco smoking, but she was a user of ENDS. When bronchoscopy was performed, an extensive pattern of suspected chemical injury was noted in her airways. She required transfer to a tertiary center where she required extracorporeal membranous oxygenation. Despite public opinion that ENDS are generally safe, or at least safer than tobacco smoking, contrary evidence is mounting. We postulate that her injuries were likely suffered secondary to use of an ENDS.