Awake ECMO for Mid-Tracheal Obstruction: When a Tracheostomy Isn't Enough

Area of Science:

• Cardiovascular Sciences
• Respiratory Medicine
• Oncology

Background:

• Near-complete tracheal obstruction presents critical airway management challenges.
• Traditional intubation and tracheostomy may be infeasible or high-risk in these patients.
• Extracorporeal membrane oxygenation (ECMO) provides cardiorespiratory support.

Purpose of the Study:

• To evaluate the utility of awake venovenous extracorporeal membrane oxygenation (VV-ECMO) in managing patients with near-complete tracheal obstruction.
• To highlight the importance of multidisciplinary coordination in this setting.

Main Methods:

• Application of awake VV-ECMO in patients with critical tracheal obstruction.
• Simultaneous airway control, including tumor debulking and stenting.
• Multidisciplinary team approach involving thoracic surgery, pulmonology, and critical care.

Main Results:

• Successful airway stabilization and immediate patient stabilization were achieved using awake VV-ECMO.
• Facilitated safe tumor debulking and stenting procedures.
• Enabled effective long-term oncologic management planning.

Conclusions:

• Awake VV-ECMO is a viable, life-saving strategy for patients with near-complete tracheal obstruction unresponsive to conventional methods.
• Early multidisciplinary collaboration is crucial for successful outcomes.
• This technique supports both immediate life support and definitive cancer treatment.