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The impossible airway: a plan

P Rosa1, E A Johnson, P J Barcia

  • 1General Surgery Service, Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii 96859-5000, USA.

Chest
|June 1, 1996
PubMed
Summary
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A novel cardiopulmonary bypass technique successfully secured a patient's airway during a life-threatening obstruction. This method enabled a controlled tracheotomy when other options failed, offering a new approach for critical airway management.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Thoracic Surgery

Background:

  • Massive airway tumors can cause near-complete obstruction, posing significant management challenges.
  • Conventional nonsurgical and surgical methods may be insufficient or too slow for emergent airway control in such cases.

Observation:

  • A patient with a massive tumor causing near-complete airway obstruction presented a critical clinical scenario.
  • Initial attempts to secure the airway using nonsurgical methods were unsuccessful.

Findings:

  • Cardiopulmonary bypass (CPB) was initiated using femoral-femoral cannulation under local anesthesia with a portable unit.
  • Intravenous anesthesia was administered subsequently, facilitating a controlled tracheotomy procedure.
  • This approach circumvented the challenges posed by the airway obstruction during the surgical intervention.

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Implications:

  • This case demonstrates the feasibility and potential utility of portable cardiopulmonary bypass as a bridge to definitive airway management in complex obstructive cases.
  • The technique offers a viable alternative when standard airway securing methods are compromised.
  • Further research into CPB applications for critical airway obstruction is warranted.