Extracorporeal Membranous Oxygenation Associated With Tracheal Procedures: An Extracorporeal Life Support Organization (ELSO) Registry Analysis

Extracorporeal membrane oxygenation (ECMO) has been primarily used for respiratory and circulatory failure, but its airway-related use has not been investigated well. Tracheal procedures are a situation when ECMO could be used to support patients during anticipated difficult airway management. The Extracorporeal Life Support Organization registry was queried for adult patients treated with ECMO in 2010-2022 during the same admission with types of tracheal procedures. Tracheal procedures were divided into surgical procedure and bronchoscopic procedure groups, and the survival rate was analyzed for each procedural type. Two-hundred sixty-nine patients met the inclusion criteria (64 surgical procedures and 205 bronchoscopic procedures), and 173 (64.3%) patients survived to discharge. Among the surgical procedures, tracheal resection was most performed (30 patients; 46.9%) and was associated with a high survival rate to discharge (86.7%; p = 0.003) compared with airway reconstruction (57.1%) and airway injury repair (46.2%). In bronchoscopic procedure, tracheal stent had favorable survival (76.1%; p = 0.004), whereas tumor debulking was associated with poor prognosis (48.3%; p = 0.006). Hemorrhagic complications were seen in 70 (26.0%) patients and were associated with a worse survival rate (58.6%; p < 0.001). Among them, surgical site bleeding was seen in 35 (13.0%) patients and was also associated with worse survival (42.9%; p = 0.007).