23: Successful Use of Veno-venous extracorporeal membrane oxygenation (VV ECMO) for Retrieval and Peri-Operative Support for a Severe Traumatic Tracheobronchial Injury

Introduction: Tracheobronchial injuries (TBIs) are infrequent in the pediatric population but are often life-threatening, requiring early diagnosis, careful evaluation, expert airway management, and surgical repair. For an unstable pediatric patient with a significant tracheobronchial injury, initiating veno-venous extracorporeal membrane oxygenation (VV ECMO) support before surgical repair may be crucial. It provides adequate respiratory support without causing further damage to the lungs and airways. It also facilitates transport to a center where subspecialized teams are available. Case Report: We present a case of using ECMO support to retrieve a patient to a center where ECMO support and a specialized surgical team were available. A 4-year-old, 17 kg previously healthy boy sustained blunt trauma to the neck and chest when a marble table fell on him. He presented to a hospital in a peripheral city with neck emphysema and respiratory failure. After initial management, which included intubation and bilateral chest tube insertion, evaluation by head, neck & chest computed tomography (CT) revealed a significant TBI. The pediatric ECMO retrieval team was activated for refractory respiratory failure and air leak and dispatched to cannulate the patient for VV ECMO successfully percutaneously, then safely transported him via Medivac to a specialized ECMO center in Riyadh, where ECMO support, advanced ICU care, specialized pediatric surgical teams were available.A successful repair of a 5 cm tracheobronchial tear was performed, and despite a postoperative complication of massive bleeding from the chest tube and hospital-acquired infection, successful weaning from ECMO was achieved, and the patient made a full recovery. Conclusion: Early ECMO initiation and a coordinated multidisciplinary approach is essential in managing pediatric tracheobronchial injuries. As a bridge to surgical repair, VV-ECMO stabilizes the patient and provides a vital window for safe transport and definitive care, particularly in severe cases with refractory respiratory failure.