Anesthetic Management of a Delayed Carinal Resection Following Traumatic Disruption

Resecting and reconstructing the carina is an anesthetic challenge in the best of circumstances. The surgery is meticulous and requires access to the trachea and bronchi, ruling out traditional lung isolation techniques. When resection of the carina is due to traumatic disruption, confounding thoracic injuries can make adequate ventilation and oxygenation difficult, especially when only one lung is available for ventilation. ECMO is an intervention that provides sufficient oxygenation and an unimpeded surgical field. ECMO also allows use of smaller airway management tools that can be used to ventilate the dependent lung, thus preventing atelectasis and producing better postoperative outcomes.