Central airway obstruction caused by neck and chest tumors is a very dangerous oncological emergency with high mortality. Unfortunately, there is few literature to discuss an effective way for this life-threating condition. Providing effective airway managements, adequate ventilation and emergency surgical interventions are very important. However, traditional airway managements and respiratory support has only limited effect. In our center, using extracorporeal membrane oxygenation (ECMO) as a novel approach to manage patient with central airway obstruction caused by neck and chest tumors has been adopted. We aimed to show the feasibility: using early ECMO to manage difficult airway, provide oxygenation and support surgical procedure for patients with critical airway stenosis caused by neck and chest tumors. We designed a single-center, small sample size retrospective study based on real-world. We identified 3 patients with central airway obstruction caused by neck and chest tumors. ECMO was used to ensure adequate ventilation to emergency surgery. Control group cannot be established. Because traditional manner very likely led to death of such patients. Details of clinical characteristics, ECMO, surgery and survival outcomes were recorded. Acute dyspnea and cyanosis were the most frequent symptoms. All patients (3/3) showed descending arterial partial pressure of oxygen (PaO2). Computed tomography (CT) revealed severe central airway obstruction caused by neck and chest tumors in all cases (3/3). All patients (3/3) had definite difficult airway. All cases (3/3) received ECMO support and emergency surgical procedure. Venovenous ECMO was the common mode for all cases. 3 patients weaned off ECMO successfully without any ECMO-related complications. Mean duration of ECMO was 3 h (range: 1.5–4.5 h). Under ECMO support, difficult airway management and emergency surgical procedure were finished successfully for all cases (3/3). The mean ICU stay was 3.3 days (range: 1–7 days), and the mean general ward stay was 3.3 days (range: 2–4 days). Pathology demonstrated the tumor dignity for 3 patients including 2 malignant cases and 1 benign case. All patients (3/3) were discharged from hospital successfully. We showed that early ECMO initiation was a safe and feasible approach to manage difficult airway for patients with severe central airway obstruction caused by neck and chest tumors. Meanwhile, early ECMO initiation could ensure security for airway surgical procedure.

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Background Central airway obstruction caused by neck and chest tumors is a very dangerous oncological emergency with high mortality. Unfortunately, due to its rare literature, no clear evidences or definitive guidelines are currently available for this life-threating condition. Providing effective airway managements, adequate ventilatory and emergency surgical interventions is very important. However, traditional airway managements and respiratory support has only limited effect. Currently, extracorporeal membrane oxygenation (ECMO) has been used to manage cardiac and respiratory failure. In our center, using ECMO as a novel approach to manage difficult airway has been adopted since 2021. In the present study, we aim to show the feasibility: using early ECMO to manage difficult airway, provide oxygenation and support surgical procedure for patients with critical airway stenosis caused by neck and chest tumors. Methods Clinical records of patients admitted for central airway obstruction caused by neck and chest tumors to the Emergency Department, West China Hospital, Sichuan University from January 2021 to December 2021 were collected. Clinico-pathological characteristics, details of ECMO, surgical management, and outcomes were analyzed. Results Three patients were admitted; Acute dyspnea and cyanosis were the most frequent symptoms at diagnosis. Laboratory findings showed abnormal descending arterial partial pressure of oxygen (PaO2). Meanwhile, CT always revealed abnormal findings: central airway obstruction caused by neck and chest tumor/mass. All cases (3/3) had definite difficult airway. All cases received ECMO support immediately and emergency surgical procedure. Venovenous ECMO was the common mode for all cases. 3 patients weaned off ECMO successfully without any ECMO-related complications. Mean duration of ECMO was 3 hours (range: 1.5–4.5 hours). Under early ECMO support, difficult airway management and emergency surgical procedure were finished successfully for all cases (3/3). The mean ICU stay was 3.3 days (range: 1–7 days), and the mean general ward stay was 3.3 days (range: 2–4 days).

Central airway obstruction caused by neck and chest tumors is a very dangerous oncological emergency with high mortality. Unfortunately, due to its rare literature, no clear evidences or definitive guidelines are currently available for this life-threating condition. Providing effective airway managements, adequate ventilatory and emergency surgical interventions is very important. However, traditional airway managements and respiratory support has only limited effect. In our center, using extracorporeal membrane oxygenation (ECMO) as a novel approach to manage patient with central airway obstruction caused by neck and chest tumors has been adopted since 2021. We aim to show the feasibility: using early ECMO to manage difficult airway, provide oxygenation and support surgical procedure for patients with critical airway stenosis caused by neck and chest tumors. Clinical records of patients admitted for central airway obstruction caused by neck and chest tumors to the Emergency Department, West China Hospital, Sichuan University from January 2021 to December 2021 were collected. Clinico-pathological characteristics, details of ECMO, surgical management, and outcomes were analyzed. Three patients were admitted; Acute dyspnea and cyanosis were the most frequent symptoms at diagnosis. Laboratory findings showed abnormal descending arterial partial pressure of oxygen (PaO2). Meanwhile, CT always revealed abnormal findings: central airway obstruction caused by neck and chest tumor/mass. All cases (3/3) had definite difficult airway. All cases received ECMO support immediately and emergency surgical procedure. Venovenous ECMO was the common mode for all cases. 3 patients weaned off ECMO successfully without any ECMO-related complications. Mean duration of ECMO was 3 hours (range: 1.5–4.5 hours). Under early ECMO support, difficult airway management and emergency surgical procedure were finished successfully for all cases (3/3). The mean ICU stay was 3.3 days (range: 1–7 days), and the mean general ward stay was 3.3 days (range: 2–4 days). Pathological examination demonstrated the etiology of critical airway stenosis caused by tumors for 3 patients. All patients (3/3) were discharged from hospital and no patients had readmissions. We show that early ECMO initiation is a safe and feasible approach to manage difficult airway for patients with severe central airway obstruction caused by neck and chest tumors. Meanwhile, early ECMO initiation can provide security for airway surgical procedure.

Background: Sintilimab (Sin) helps the body to restore the anti-tumor response of T lymphocytes. However, in clinical use, the treatment process is more complicated due to adverse effects and different dosing regimens. It is not clear whether prebiotics (PREB) have a potentiating effect on Sin for lung adenocarcinoma, and this study intends to investigate the inhibitory effect, safety and possible mechanism of Sin combined with PREB on lung adenocarcinoma from animal experiments. Methods: Lewis lung adenocarcinoma cells were inoculated into the right axilla of mice subcutaneously to prepare the Lewis lung cancer mouse model and treated in groups. The volume of transplanted tumors was measured, the histopathology of the liver and kidney of mice was observed by H&E staining, the levels of ALT, AST, UREA, CREA, WBC, RBC, and HGB in blood were analyzed biochemically; the ratio of T-cell subpopulations in blood, spleen, and bone marrow was detected by flow cytometry, the expression of PD-L1 in tumor tissue was detected by immunofluorescence staining, and 16S rRNA to analyze the diversity of fecal flora. Results: Sin inhibited tumor growth and regulated immune cell homeostasis in lung adenocarcinoma mice, but liver and kidney histopathology showed different degrees of damage after Sin treatment, while the addition of PREB reduced liver and kidney damage in lung adenocarcinoma mice and promoted Sin's regulation of immune cells. In addition, the beneficial effects of Sin were associated with changes in intestinal flora diversity. Conclusion: The mechanism by which Sintilimab combined with prebiotics inhibits tumor volume and regulates immune cell subpopulation balance in lung adenocarcinoma mice may be related to gut microbes.