Emergency Bedside Extracorporeal Membrane Oxygenation for Rescue of Acute Tracheal Obstruction

Abstract

A 39-year-old man experienced total obstruction of a distal tracheal plastic stent by a tumor mass, preventing effective ventilation and resulting in cardiac arrest. Resuscitation by emergency bedside venoarterial extracorporeal membrane oxygenation (ECMO) permitted time to physically remove the obstructing tumor and reestablish successful ventilation and liberation from ventilatory support. We review several other reported cases of emergency ECMO to resuscitate patients with acute airway obstruction.

Use of Single-Cannula Venous-Venous Extracorporeal Life Support in the Management of Life-Threatening Airway Obstruction

“…In most instances, ECLS has been used in the setting of cardiopulmonary resuscitation in which venoarterial ECMO was used [1,2]. Lang and colleagues [3] recently published their experience with venoarterial ECMO for the intraoperative management of complex tracheobronchial resections with sternotomy or thoracotomy.…”

Anesthetic management with extracorporeal membrane oxygenation in a patient with acute airway obstruction after inhalation burn injury -A case report-

“…Although ECMO was originally designed to support cardiac surgery, several reports have revealed that ECMO use can be a successful salvage maneuver in cases of lower airway obstruction [12,13]. ECMO provides sufficient gas exchange until airway patency is restored [14].…”

Principles and indications of extracorporeal life support in general thoracic surgery

“…Historically full CPB support was instituted via femoral venous and arterial catheters placed under local anesthesia (14). More recently, VV-ECMO support has been reported for endotracheal tumor resection (15,16), dislodged stents (15,17), foreign body removal (18), control of hemoptysis (19), debridement of papillomatosis (20) and relief of external compression (15,21,22) in adults. A variety of cannulation strategies have been reported: femoral and jugular single lumen catheters (15,18,20) and bi-caval dual lumen catheter in the right jugular vein (16,22) have been described.…”

“…Emergency VA and VV ECMO has been reported after resuscitation from cardiopulmonary arrest due to airway obstruction (16,17). While VV support was successful in a hypoxic patient where hemodynamic stability had been restored, if there is post arrest myocardial dysfunction, VA ECMO is a better choice.…”