The very young and the very old are vulnerable to choking, and there are over 4000 choking-related deaths annually in the United States. Complications from the Heimlich maneuver (HM), as reported in infrequent case reports, predominantly relate to the elderly. It is doubtful that the denominator, numerator, appropriateness, expertise, and problems of maneuvers applied to choking victims will ever be known. This case report and literature review suggests that the treatment for acute elderly choking victims should be applied carefully and that esophageal food impaction, which should be rapidly distinguishable from choking, can have serious complications with application of the HM.

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Extracorporeal membrane oxygenation, traditionally used to treat refractory hypoxemic respiratory failure due to acute respiratory distress syndrome, is being used to treat other etiologies of severe respiratory failure refractory to conventional mechanical ventilation. We present a 30-year-old woman with concomitant life-threatening airway obstruction due to severe tracheal stenosis and status asthmaticus treated effectively with veno-venous extracorporeal membrane oxygenation. KEYWORDS Acute severe asthma; extracorporeal membrane oxygenation; tracheal stenosisO bstruction of the central airways, the trachea and mainstem bronchi, can complicate many disease processes and in tracheal stenosis can be a complication of prior tracheostomy placement due to excess scar tissue formation. Asthma is an allergic condition characterized by bronchoconstriction with periods of exacerbation and remission. During severe exacerbations, patients may need mechanical ventilation. Severe asthma exacerbation in a patient with a compromised central airway due to tracheal stenosis can be challenging to manage. Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) involves diversion of blood for extracorporeal oxygenation and carbon dioxide removal by an artificial "membrane lung" and is a salvage treatment for respiratory failure. There are reports of successful outcomes where VV ECMO has enabled performance of lifesaving procedures in high-risk patients with central airway obstruction. 1