Severe tracheal tear - an alternative extracorporeal membrane oxygenation indication

Conservative management is usually preferred for iatrogenic tracheal injuries. Venovenous extracorporeal membrane oxygenation (V-V ECMO) is mostly used in acute refractory hypoxemia, airway lesions are an alternative indication.

A 51-year-old female was transferred with a large tracheal tear after plastic tracheotomy. Due to a critical ventilation situation with hypercapnia, conservative management was set and V-V ECMO was installed. With optimized tube positioning, minimal ventilation and gas transfer via V-V ECMO, a complete healing of the injury could be achieved.

Fast diagnosis of tracheal injuries is essential; transfer to a specialized centre should be considered. In our case, organ support via ECMO was necessary due to a difficult ventilation situation with persisting hypercapnia. Thus, reduction in ventilation pressures with reduction of possible leakage and healing of the tracheal tear could be achieved.

Management of tracheal tears is complex; in severe cases special therapy concepts such as the use of V-V ECMO may become necessary.