Tracheostomy using extracorporeal membrane oxygenation in a patient with subglottic stenosis

Masayuki Shirakura, Kenichi Watanabe, Hikaru Hashimoto, Youhei Honkura, Eiichi Ishida, Kazuhiro Nomura, Yukio Katori

Research output: Contribution to journalArticlepeer-review

Abstract

Clinical management of airway stenosis is often challenging. We report our experience of performing semi-emergent tracheostomy under extracorporeal membrane oxygenation (ECMO) support in a patient with subglottic airway stenosis. A 33-year-old female patient was admitted with a 3-months' history of dyspnea. She had a breathy voice and mild stridor. Fiberoptic laryngoscopy and CT revealed subglottic stenosis caused by an unknown lesion destroying a part of the cricoid cartilage. Although securing of the airway was required, there was a risk of CVCI (cannot ventilate and cannot intubate) when attempting tracheal intubation. Furthermore, even we, as otolaryngologists, found it extremely difficult to safely perform tracheostomy under local anesthesia, because of the possibility of the lesion affecting the trachea below the cricoid cartilage, presence of a diffuse swollen thyroid gland due to Basedow disease, and moderate obesity. Therefore, we planned to perform tracheostomy under ECMO for maintaining oxygenation. Subsequently, after the anesthesiologist managed to successfully intubate the patient, ECMO was withdrawn and tracheostomy was uneventfully performed under general anesthesia. We consider airway management under ECMO to be useful in patients in whom both tracheal intubation and tracheostomy are considered high risk.

Original languageEnglish
Pages (from-to)1395-1400
Number of pages6
JournalJournal of Otolaryngology of Japan
Volume121
Issue number11
DOIs
Publication statusPublished - 2018

Keywords

  • Clinical management of airway stenosis
  • ECMO
  • Extracorporeal circulation
  • Subglottic stenosis

ASJC Scopus subject areas

  • Otorhinolaryngology

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