19: ECMO to the Rescue: Managing Catastrophic Decompensated Tracheal Obstruction

Background: Airway obstruction is rare but highly critical. Patients often present with nonspecific symptoms and airway compromise may progress rapidly. Conventional airway management strategies are frequently limited. In this context, extracorporeal membrane oxygenation (ECMO) has emerged as a lifesaving adjunct, providing adequate gas exchange when conventional approaches fail. Case Presentation: A 53-year-old female, previously healthy, presented with shortness of breath and hemoptysis for one week. She was tachycardic but otherwise hemodynamically stable, with oxygen saturation maintained on room air. Her physical examination was positive for wheezing. A suspicion of pulmonary embolism was raised as she has normal chest x-ray and normal inflammatory markers. CT pulmonary angiography revealed endotracheal lesion located 4.9 cm from the tracheal bifurcation. The lesion infiltrated the right tracheal wall, causing 70% luminal narrowing, with extratracheal extension contacting the right thyroid lobe and partially encasing the right common carotid artery. The patient’s condition deteriorated with worsening hypoxemia, awake fiberoptic intubation was tried to secure the airway but failed because of significant narrowing distal to the vocal cords. Elective insertion of Veno-Venous ECMO (VV-ECMO) was done as a bridge for further intervention. She underwent rigid bronchoscopy with biopsy followed by tumor debulking and tracheostomy. Histopathology confirmed a high-grade tracheal malignancy. The patient was successfully weaned off ECMO after three days and gradually was weaned from ventilator and kept on tracheal mask and later discharged to the Oncology ward for further management. Conclusion: This case highlights the role of VV-ECMO in managing complex airway emergencies. By providing time and stability, ECMO can serve as an essential bridge to definitive bronchoscopic and surgical interventions when conventional airway management fails. Broader clinical recognition of ECMO’s utility in similar scenarios may expand safe treatment options for high-risk airway cases.