The Feasibility of Extracorporeal Membrane Oxygenation in the Variant Airway Problems

Abstract

Introduction: Extracorporeal membrane oxygenation (ECMO) is widely used to treat respiratory distress during cardiac or respiratory arrest; moreover, its use is being extended to a wide variety of clinical fields. In this study we assess the utility of ECMO in the management of airway obstruction.

Patients and methods: 15 patients underwent ECMO for airway obstruction. We retrospectively analyzed and evaluated the feasibility of ECMO in the treatment of airway problems.

Results: Seven patients received ECMO to facilitate respiration and promote stability during trachea surgery. In six cases ECMO ceased immediately following the operation; in the remaining case ECMO cessation was delayed due to post-operative ARDS. In three cases emergency ECMO was used in response to respiratory arrest; two patients died. In five cases ECMO was emergently inserted to prevent death, following airway blockade by massive hemoptysis. One patient was not discharged from the intensive care unit. Another patient was transferred to a general ward but died from other causes.

Conclusion: ECMO is useful during anesthesia in patients at high risk of airway blockade, for example due to endobronchial bleeding, and during complex thoracic surgery. ECMO confers a safer environment during airway surgery, and its complication rate is acceptable.

Fig. 1

(a) VV ECMO (femoral drain and jugular return). (b) VV ECMO (femoral drain and femoral return). (c) VA ECMO (femoral drain and femoral artery return). (d) VV ECMO (femoral drain and jugular vein and femoral artery return). VV ECMO: veno-venal extracorporeal membrane oxygenation; VA ECMO: veno-arterial extracorporeal membrane oxygenation