An atypical airway cast.

Area of Science:

• Pulmonology
• Critical Care Medicine
• Emergency Medicine

Background:

• Smoke inhalation can lead to severe airway injury.
• Decompensated hypercapnic respiratory failure presents a critical challenge.
• Airway obstruction from slough and pseudomembrane formation is a rare but serious complication.

Purpose of the Study:

• To report a case of severe inhalation injury with airway cast formation.
• To highlight the utility of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in managing such cases.
• To demonstrate successful airway cast removal with VV-ECMO support.

Main Methods:

• A 60-year-old male patient with smoke inhalation underwent intubation.
• Fiberoptic bronchoscopy identified obstructive airway slough and pseudomembrane.
• Veno-venous extracorporeal membrane oxygenation (VV-ECMO) was initiated for stabilization.
• Airway casts were removed during the VV-ECMO support.

Main Results:

• The patient presented with decompensated hypercapnic respiratory failure post-smoke inhalation.
• Bronchoscopy confirmed severe inhalation injury manifesting as airway casts.
• VV-ECMO provided essential hemodynamic and respiratory support.
• Successful removal of the obstructive airway casts was achieved.

Conclusions:

• Airway cast formation is a critical complication of severe smoke inhalation.
• VV-ECMO is a valuable tool for stabilizing patients with severe airway obstruction.
• Periprocedural VV-ECMO facilitates successful intervention for life-threatening airway casts.