ECMO-assisted bronchoscopic therapy for severe tracheal stenosis: a case report and literature review.

Abstract

Background: Severe tracheal stenosis is a life-threatening condition that often requires immediate intervention. Traditional surgical approaches may be challenging in critically ill patients, and bronchoscopic therapies have emerged as a less invasive alternative. However, maintaining adequate oxygenation and ventilation during these procedures can be challenging, especially in patients with near-complete airway obstruction. The manipulation of the already compromised airway during bronchoscopy can exacerbate respiratory insufficiency, leading to hypoxemia, hypercapnia, and even cardiac arrest. To address these challenges, extracorporeal membrane oxygenation (ECMO) has been increasingly utilized as a supportive measure during high-risk airway interventions. The use of ECMO in managing severe tracheal stenosis is a relatively recent development, with growing evidence supporting its role in facilitating complex airway interventions. By ensuring hemodynamic stability and adequate gas exchange, ECMO enables the safe and effective application of bronchoscopic techniques in critically ill patients who would otherwise be deemed unsuitable for such procedures. This approach can improve outcomes and expand treatment options for patients with severe tracheal stenosis.

Case presentation: A 49-year-old woman, who underwent metal stent placement in her upper trachea 24 years ago due to tuberculous tracheal stenosis, was hospitalized due to worsening dyspnea. A thorough evaluation showed that the entire tracheal section was narrowed, with the smallest diameter measuring approximately 4-5 mm. Traditional respiratory support was inadequate for maintaining the patient's oxygen levels during bronchoscopy. We conducted bronchoscopic treatment with ECMO support, significantly alleviating the patient's dyspnea symptoms post-treatment. This is the first documented case of ECMO being utilized alongside bronchoscopy for patients with tracheal narrowing caused by tuberculosis.

Conclusion: The case study described a patient experiencing severe tracheal scar stenosis due to tuberculosis, who underwent successful treatment that included bronchoscopy supported by ECMO. Our effective handling of this case has provided crucial insights and strategies for managing similar situations in the future.