Intraoperative Airway Management Using Veno-Venous Extracorporeal Membrane Oxygenation for Airway Obstruction From Diffuse Idiopathic Skeletal Hyperostosis at the Thoracic Inlet: A Case Report

We report a case of airway obstruction caused by diffuse idiopathic skeletal hyperostosis (DISH) at the thoracic inlet, in which surgical treatment was successfully performed using veno-venous extracorporeal membrane oxygenation (VV-ECMO) for intraoperative respiratory support. The patient, a 71-year-old man, presented with progressive dyspnea. CT revealed significant airway narrowing at the thoracic inlet due to bony overgrowth consistent with DISH. Although bone resection was planned, tracheal intubation was considered difficult because of severe airway stenosis. To safely manage ventilation during surgery, VV-ECMO was temporarily initiated for respiratory support. The sternum was then vertically split to relieve the stenosis, allowing successful tracheal intubation and subsequent surgical resection of the osteophytes. This case highlights the potential role of VV-ECMO as a bridge to secure intraoperative airway control in patients with critical airway obstruction caused by space-occupying lesions at the thoracic inlet.