Perioperative extracorporeal membrane oxygenation support for critical pediatric airway surgery

Abstract

Extracorporeal membrane oxygenation (ECMO) has been used for cardiopulmonary support in neonates, infants, and adults. We report the application of ECMO for critical airway surgery when mechanical ventilation cannot provide adequate gas exchange. Three pediatric patients underwent emergency ECMO establishment because of hypercapnia that could not be managed by conventional mechanical ventilation. The pathology included: (1) left pulmonary artery sling with long-segment tracheal stenosis; (2) absence of the right intermediate bronchus and abnormal origin of the right lower bronchus arising from the left main bronchus; (3) right-lung agenesis with long-segment tracheobronchial stenosis. Venoarterial ECMO was established. Before ECMO, the arterial pH values were 7.28, 7.0, and 7.08, and the PaCO2 values were 111.8, 112.0, and 208.7 mmHg for each patient, respectively. After ECMO support, respiratory acidosis was reversed. The patients then underwent surgical intervention. The surgical procedures included: (1) slide tracheoplasty and reimplantation of the left pulmonary artery; (2) resection of the stenotic tracheal segment and reconstruction of the bronchial tree; (3) tracheal dilatation and stent implantation. The ECMO durations were 11, 5, and 16 h, respectively. All patients were successfully weaned off ECMO without complications. In conclusion, ECMO provided adequate ventilation support for patients undergoing critical tracheobronchial reconstruction when conventional mechanical ventilation could not maintain adequate gas exchange.

Pediatric airway surgery

“…A combined repair of the tracheal stenosis and the cardiovascular malformation is required, necessitating cardiopulmonary bypass. If there is no concomitant defect, the operation can also be performed using ECMO for maintaining oxygenation (45). Due to the excellent results of slide tracheoplasties some centers have expanded their indication to children with intermediate and even shortsegment stenosis (43).…”

Clinical equivalency of cardiopulmonary bypass and extracorporeal membrane oxygenation support for pediatric tracheal reconstruction

“…However, in recent years, ECMO is increasingly being used [7][8][9][10]. The disadvantages of CPB include potentially high risks of intraoperative bleeding, the increased need for blood products because of full systemic heparinization [11] and fluid overload because of the extracorporeal circulation [12,13].…”

Acute Upper-Airway Obstruction by a Lingual Thyroglossal Duct Cyst and Implications for Advanced Airway Management

“…21 Alternatively, extracorporeal membrane oxygenation (ECMO) may be needed as a bridge to definitive surgical intervention in neonates, infants, and children with significant upper airway obstruction in whom an artificial airway cannot be established. 22, 23 …”