Extracorporeal Membrane Oxygenation Without Mechanical Ventilation for Recovery From Tracheal Repair

Area of Science:

• Thoracic surgery
• Critical care medicine
• Respiratory physiology

Background:

• Large intrathoracic airway repairs are challenging.
• Postoperative positive pressure ventilation (PPV) can impede healing of these repairs.
• Severe emphysema poses additional risks for airway management.

Observation:

• A 67-year-old woman with severe emphysema sustained a full-length transmural intrathoracic tracheal intubation injury.
• Following surgical repair, the patient could not tolerate extubation or PPV distal to the repair site.
• Mediastinitis complicated the postoperative course.

Findings:

• Prolonged venovenous extracorporeal membrane oxygenation (ECMO) was initiated for 13 days.
• ECMO provided oxygenation and ventilation support without the need for PPV.
• This allowed for unimpeded healing of the large airway repair.

Implications:

• This case demonstrates a potentially life-saving alternative to PPV in specific complex airway reconstructions.
• Venovenous ECMO may be a valuable tool for managing patients with intrathoracic airway injuries who cannot tolerate conventional ventilation.
• Further research is warranted to explore the broader applicability of this technique in thoracic surgery and critical care.