Veno-Venous Extracorporeal Membrane Oxygenation for High-Risk Airway Interventions: A Safety-Net Hospital Case Series

High-risk airway interventions in patients with critical airway obstruction carry a substantial risk of respiratory failure, and conventional ventilation strategies may be inadequate to ensure procedural safety. Consequently, some patients are denied potentially life-saving or palliative interventions. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has emerged as an adjunctive strategy to provide temporary respiratory support during complex airway procedures, though evidence remains limited. We present a case series of three patients with near-complete airway obstruction who underwent planned VV-ECMO-assisted therapeutic airway interventions at a safety-net hospital. Indications included severe benign tracheal stenosis and malignant central airway obstruction. In all cases, VV-ECMO enabled rigid bronchoscopy and multimodal airway intervention without intraprocedural respiratory decompensation or reliance on conventional ventilation. All patients experienced rapid symptomatic improvement, were successfully decannulated, and had favourable outcomes. These cases demonstrate that planned VV-ECMO can safely facilitate high-risk airway interventions and highlight its feasibility in a safety-net setting, with implications for expanding equitable access to advanced airway rescue strategies.