Application of extracorporeal membrane oxygenation (ECMO) in tracheal tumor resection

Objective: Normal gas exchange and sufficient oxygenation are key preconditions for tracheal tumor resection. Due to the complex of diseases, conventional airway management during anesthesia, in some special cases, may meet some difficulties or risks. Then, some other options should be considered. We presented three cases where extracorporeal membrane oxygenation (ECMO) was used for cardiopulmonary support during complex airway reconstruction. Case Report: Case 1 is a patient with left bronchial squamous cell carcinoma, who previously underwent left pneumectomy and now presented for carinal resection. Case 2 is a patient with a space-occupying lesion in the trachea, just above the carina and extending into the left main bronchus, with severe respiratory insufficiency and high airway resistance on mechanical ventilation. Case 3 is a patient with a near-occlusive, hemorrhagic upper tracheal mass. In all three cases, veno-arterial or veno-venous ECMO was applied during surgical resection. Results: All three patients underwent successful tracheal resection. When veno-arterial ECMO was applied, discontinuous mechanical ventilation was still required to maintain oxygenation. This was not the case for veno-venous ECMO. Conclusion: ECMO may be applied as an option of cardiopulmonary support during tracheal resection. Gas exchange is preserved while good surgical access for tracheal operations is maintained. The use of ECMO during tracheal resection is recommended for tumors invading, obstructing, or proximal to the carina, main or left bronchial lesions in which left pneumectomy was previously performed, and in patients with tracheal tumors who have difficult access for tracheotomy.