Extracorporeal Membrane Oxygenation, Extubation, and Lung-Recruitment Maneuvers as Rescue Therapy in a Patient With Tracheal Dehiscence Following Slide Tracheoplasty

Raake, Jenni L.; Johnson, Bethann; Seger, Brandy; Manning, Peter B.; Eghtesady, Pirooz; Boesch, Paul; Rutter, Michael J.; Woodard, Amanda; Chima, Ranjit S.

doi:10.4187/respcare.00948

Cited by 17 publications

(10 citation statements)

References 31 publications

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“…93 Taken a step further, some centers have reported successful extubation during ECMO support. [94][95][96][97] In the largest single-center series, Anton-Martin et al described 16 subjects ranging in age from 2 d to 17 y old who were successfully extubated at some point during their ECMO treatment provided between the years 2010 and 2013. 97 In 12 of these cases, refractory respiratory failure necessitated ECMO support, 2 additional cases had mediastinal masses, and the remaining 2 had cardiac failure requiring ECMO.…”

Section: Ventilator Management During Ecmomentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for Severe Pediatric Respiratory Failure

Lin

2017

Respir Care

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Extracorporeal membrane oxygenation (ECMO) was developed initially in the 1960s to support refractory respiratory failure in addition to the cardiac support inherent in a venoarterial bypass circuit. Early successes occurred predominantly in the neonatal population with subsequent randomized controlled trials and comprehensive reviews concluding therapeutic efficacy for ECMO in neonatal respiratory failure. In contrast, the evidence supporting ECMO for respiratory failure in children is less definitive. However, although pediatric randomized controlled trials have not been completed, sufficient evidence in support of ECMO as a beneficial therapy for pediatric respiratory failure exists. The acceptance of clinical utility and benefit from ECMO for pediatric ARDS and the trend toward increasing venovenous ECMO use have led to its inclusion in the Pediatric Acute Lung Injury Consensus Conference as a strongly agreed upon recommendation for severe pediatric ARDS. However, the Pediatric Acute Lung Injury Consensus Conference recommendations supporting the use of ECMO for pediatric ARDS highlight the lack of evidence-based selection criteria when determining ECMO candidacy in pediatric patients with ARDS. Ultimately, decisions to proceed with ECMO and the concomitant risk of potential life-threatening complications must consider multiple factors that balance potential risks and likelihood of benefit, pre-morbid conditions and impact on potential post-ECMO quality of life, candidacy for lung transplantation, and patient and family goals of care. This review will discuss ECMO for the support of pediatric respiratory failure, ventilator management during ECMO, considerations impacting timing of decannulation, and developing techniques.

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Section: Ventilator Management During Ecmomentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for Severe Pediatric Respiratory Failure

Lin

2017

Respir Care

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“…With the failure of what is usually the final step in the algorithm, the anesthesia team in consultation with other surgical specialists opted for venovenous bypass as a means to oxygenate and anesthetize a patient whose airway could not be secured. While extracorporeal membrane oxygenation (ECMO) has been utilized and reported in the pediatric population fairly extensively, venovenous bypass has only rarely been reported in the literature as a means of oxygenation in the setting of the impossible airway in an adult, often in the setting of a large thyroid or mediastinal tumor or severe tracheal trauma [2, 3]. Rosa and colleagues and Jeon and colleagues both presented cases of cardiopulmonary bypass being safely utilized in this manner for cases of a cervical and thyroid tumor, respectively [4, 5].…”

Section: Discussionmentioning

confidence: 99%

Impossible Airway Requiring Venovenous Bypass for Tracheostomy

Gardes

Straker

2012

Case Reports in Anesthesiology

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The elective surgical airway is the definitive management for a tracheal stenotic lesion that is not a candidate for tracheal resection, or who has failed multiple-tracheal dilations. This case report details the management of a patient who has failed an elective awake tracheostomy secondary to the inability to be intubated as well as severe scar tissue at the surgical site. A combination of regional anesthesia and venovenous bypass is used to facilitate the surgical airway management of this patient. Cerebral oximetry and a multidisciplinary team approach aid in early detection of an oxygenation issue, as well as the emergent intervention that preserved this patient's life.

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“…However, in very critical stenosis without tracheostomy, preoperative tracheal dilation or intraoperative veno-veno ECMO could be considered. 17,18) Of them, the tracheal dilation might cause airway obstruction, so veno-veno ECMO was preferred as one of safe methods until securing distal airway in our study. Although few cases with use of ECMO to support ventilation during tracheal surgery have been reported, ECMO was successfully used in four patients with TS without tracheostomy of our study.…”

Section: Resultsmentioning

confidence: 99%