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Case Reports
. 2025 Jan 4;17(1):e76890.
doi: 10.7759/cureus.76890. eCollection 2025 Jan.

E Before A: Awake Bi-femoral Veno-Venous Extracorporeal Membrane Oxygenation as a Bridge to the Bifurcation Tracheal Y Stent

Elliott T Worku  1   2 , Michael G Pittard  2 , Ruaidhri Carey  2
Affiliations
Case Reports

E Before A: Awake Bi-femoral Veno-Venous Extracorporeal Membrane Oxygenation as a Bridge to the Bifurcation Tracheal Y Stent

Elliott T Worku et al. Cureus. .

Abstract

A 64-year-old female presented with severe respiratory failure secondary to a high-grade non-small lung cancer (IIIA NSCLC) causing extrinsic and intrinsic compression of the right main bronchus. She remained hypoxic despite 100% FiO2 delivery by high-flow nasal cannula and was considered at high risk of airway loss at intubation. Tumor debulking, histological diagnosis, and restoration of airway patency were facilitated with peri-procedural veno-venous extracorporeal membrane oxygen support (VVECMO). We describe a case of awake bifemoral VVECMO cannulation performed uneventfully as a bridge to the palliative placement of a self-expanding tracheal Y stent. The circuit was maintained in the absence of systemic anticoagulation. After less than 24 hours of extracorporeal support, the patient was decannulated, liberated from supplementary oxygen, and discharged from intensive care. The patient is now receiving platinum-based chemoradiotherapy and is eligible for targeted consolidative immunotherapy. As therapies and practice evolve, extracorporeal support may serve as a bridge to palliative interventions intended to salvage and improve the quality of life in oncology patients. Awake cannulation is feasible and may be preferred in cases of malignant airway obstruction.

Keywords: airway procedures; awake technique; central airway obstruction; hypoxic respiratory failure; non-small cell lung carcinoma (nsclc); tracheal stenting; veno-venous extracorporeal membrane oxygenation (vv ecmo).

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Sydney Local Health District issued approval NA. This research conforms to the low-/negligible-risk pathway and is exempt from ethical consideration. . Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Computed tomography (CT) and chest X-ray (CXR) imaging demonstrating a large mixed-density mediastinal mass causing right main bronchus compression and right middle and lower lobe collapse: (a) sagittal, (b) coronal, (c) axial, and (d) AP-CXR.
Figure 2
Figure 2. CXR post VVECMO cannulation.
Multistage access cannula at the cavo-atrial junction (blue arrow) and single-stage return cannula (red arrow) positioned in the mid-right atrium. CXR, chest X-ray; VVECMO, veno-venous extracorporeal membrane oxygen
Figure 3
Figure 3. Fluoroscopy: Rigid bronchoscopy deployment of bifurcation wires to guide tracheal Y stent during apnoeic period.
The VVECMO single-stage return cannula is denoted by the white arrow. VVECMO, veno-venous extracorporeal membrane oxygen
Figure 4
Figure 4. Postoperative AP CXR demonstrating reversed nitinol-coated Y stent (note: position with long left main bronchus projection intentionally deployed to the RMB) with sacrifice of the right upper lobe (RUL), but restoration of right middle lobe (RML) and right lower lobe (RLL) aeration.
AP CXR, anteroposterior chest X-ray; RMB, right main bronchus
See this image and copyright information in PMC

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