Perioperative Airway Management of a Mediastinal Mass through Early Intervention with Extracorporeal Membrane Oxygenation [ECMO] - Abstract
Venous-venous extracorporeal membrane oxygenation [ECMO] can be life saving in clinical situations where awake, fiberoptic intubation or tracheostomy were indicated but were not feasible because of critical airway obstruction in the lower airways. We present a case of unusual airway obstruction by a neck mass extending in the mediastinum in a young adult. A flexible fiberoptic bronchoscope was used to confirm the extent of external compression and airway obstruction. The nature of invasion was concerning for bleeding and obstruction of the airway if we attempted to manipulate the airway by fiberoptic intubation. The extension of the mass into the chest prevented other methods for securing the airway such as retrograde intubation or awake tracheostomy. There was also a concern that the use of standard induction and neuromuscular blocking drugs would cause irreversible tracheal compression or cardiovascular compromise. ECMO was utilized to provide safe oxygenation while establishing a definitive airway.