41: Extra of Extracorporeal

Background: Tracheal stenosis may be congenital or acquired due to trauma, prolonged intubation, or malignancy. Severe or anatomically complex stenosis can make endotracheal intubation and ventilation extremely challenging, particularly during surgical repair requiring prolonged apnea and an unobstructed operative field. In such cases, extracorporeal membrane oxygenation (ECMO) can provide complete gas exchange support, allowing safe “tubeless” airway surgery. Case Description: A 64-year-old male was diagnosed with circumferential tracheal thickening at the D2–D3 level, resulting in an 8 cm segment of moderate tracheal narrowing. Due to anticipated difficulty with ventilation and airway control, tracheal ring resection was planned with veno-venous extracorporeal membrane oxygenation (VV-ECMO) support. VV-ECMO was initiated prior to surgical intervention to provide continuous oxygenation and carbon dioxide clearance. The procedure involved two planned periods of apnea, with a cumulative apnea duration of 3.5 hours. Throughout the apneic phases, the patient maintained stable hemodynamics and oxygen saturation of 100% under ECMO support. ECMO was continued postoperatively until the following day as a precautionary measure. The patient’s postoperative course was uneventful, and he was discharged on postoperative day 11. Conclusion: This case demonstrates the utility of VV-ECMO as a safe and effective adjunct during complex tracheal surgery requiring prolonged apnea and tubeless surgical conditions. ECMO support enables optimal surgical exposure while maintaining adequate gas exchange, reducing perioperative risk in patients with severe tracheal stenosis and difficult airways.