Extracorporeal membrane oxygenation support in patients with difficult airway management: Case series of 13 patients

In critical care practice, difficult airway management poses a substantial challenge, necessitating urgent intervention to ensure patient safety and optimize outcomes. Extracorporeal membrane oxygenation (ECMO) is a potential rescue tool in patients with severe airway compromise, although evidence of its efficacy and safety remains limited.

To review the local experience of using ECMO support in patients with difficult airway management.

This retrospective case series study includes patients with difficult airway management who required ECMO support at a tertiary hospital in a Middle Eastern country.

Between 2016 and 2023, a total of 13 patients required ECMO support due to challenging airway patency in the operating room. Indications for ECMO encompassed various diagnoses, including tracheal stenosis, external tracheal compression, and subglottic stenosis. Surgical interventions such as tracheal resection and anastomosis often necessitated ECMO support to maintain adequate oxygenation and hemodynamic stability. The duration of ECMO support ranged from standby mode (ECMO implantation is readily available) to several days, with relatively infrequent complications observed. Despite the challenges encountered, most patients survived hospital discharge, highlighting the effectiveness of ECMO in managing difficult airways.

This study underscores the crucial role of ECMO as a life-saving intervention in selected cases of difficult airway management. Further research is warranted to refine the understanding of optimal management strategies and improve outcomes in this challenging patient population.