Anesthesia management of challenging airway cases using intraoperative extracorporeal membrane oxygenation - A case...

The intersection of complex airway management and intraoperative venovenous extracorporeal membrane oxygenation (VV-ECMO) presents a unique challenge, demanding a comprehensive understanding of both domains. This study examines patients undergoing complex airway surgical procedures under anesthesia with concurrent ECMO between January 2023 and May 2024. It focuses on the challenges during surgery, perioperative complications, and critical care outcomes with tailored anesthesia approaches in four clinical scenarios: 1) Tracheal stenosis requiring resection and anastomosis, 2) pulmonary alveolar proteinosis necessitating whole lung lavage, 3) carcinoma esophagus infiltrating the tracheal lumen causing upper airway obstruction and stridor managed with tumor debulking and stenting, and 4) adenoid cystic carcinoma of the trachea causing central airway obstruction with progressive stridor needing intratracheal stent placement. ECMO has become essential in advancing modern-day thoracic surgery's scope and safety. The case series underscores the critical role of ECMO in facilitating surgery by ensuring adequate gas exchange and maintaining hemodynamic stability and contributes to the evolving understanding of perioperative strategies, complications, and outcomes of various airway pathologies and guiding future approaches to enhance overall patient care.