Extracorporeal oxygenation for airway rescue: veno-venous ECMO in critical tracheal stenosis management: a single-centre case series.

Abstract

Managing life-threatening airway obstruction, such as critical tracheal stenosis, poses a significant challenge. Veno-venous extracorporeal membrane oxygenation (VV ECMO) offers an important lifeline by providing extracorporeal gas exchange and stabilizing patients for definitive airway procedures. This study presents four cases of severe tracheal stenosis successfully managed with VV ECMO. The cases include a young male with a retropharyngeal mass, a pregnant woman with a mediastinal mass leading to tracheal and superior vena cava obstructions, a female patient with large anterior mediastinal mass, and an elderly male with metastatic adenocarcinoma causing critical airway narrowing. VV ECMO allowed for safe tracheal stenting and biopsies to be performed. The outcomes were favorable, with patients weaned off ECMO as early as 6 h post-procedure and extubated within days post-ECMO termination. VV ECMO ensures effective oxygenation during high-risk airway interventions where conventional methods might fail. It acts as a bridge to definitive procedures such as tracheal stenting in which conventional airway strategies such as intubation is not a viable option. Advanced imaging such as image intensifiers has been described in our series to be an important tool for VV ECMO cannulation as compared to transthoracic echocardiography alone. Percutaneous cannulation strategies are also something to ponder upon. Although ECMO poses risks such as bleeding, thrombosis, and infection, its benefits cannot be denied in these groups of patients. VV ECMO is undeniably an indispensable tool in managing severe airway obstructions in which the conventional airway management techniques are inadequate. Further studies are warranted to refine ECMO protocols and expand its applications in airway crises.