33: ECMO: A Lifeline for Complex Airway Obstructions

Introduction: Central airway obstruction due to tracheal stenosis, endotracheal lesions, or external compression by tumors presents a significant challenge for anesthesiologists. Traditional airway management techniques often fail in these cases, leading to critical outcomes. Extracorporeal membrane oxygenation (ECMO) has been used successfully for severe respiratory failure but has limited evidence in airway obstruction. Methods: We conducted a retrospective case series of 13 patients with difficult airway intubation who were referred to receive ECMO support. The aim was to explore the benefits and risks of ECMO in this context. Results: Our analysis revealed that ECMO was used as a rescue therapy in 6 of the 13 patients. The primary indication for ECMO was near-total tracheal obstruction due to tumors (n=9). Other indications included subglottic tracheal stenosis (n=2) and external tracheal compression (n=2). The mean duration of ECMO support was 5.2 days (range: 45 minutes - 16 days). All patients who underwent ECMO cannulation survived subsequent surgical interventions without major complications. One patient died due to refractory hypoxemia and multi-organ failure after ECMO decannulation. Another patient required two surgical procedures. During the initial surgery he survived under ECMO support. However, during the second procedure, ECMO was not available, and the patient died due to failed intubation. Conclusion: Our findings suggest that ECMO can be a valuable approach in managing complex airway obstructions, particularly in cases where traditional airway management techniques have failed. While ECMO is associated with risks, the potential benefits, including improved survival and reduced mortality, outweigh the complications in many cases. We advocate for early ECMO in anticipated difficult cases and institutional protocols for its use. Further research is needed to establish definitive guidelines and to evaluate the long-term outcomes of patients who receive ECMO for difficult airway intubation.