Bluntly traumatic tracheal transection: usefulness of percutaneous cardiopulmonary support for maintenance of gas exchange

Abstract

Respiratory management of tracheal injuries is a crucial key to successful treatment. We present herein a patient with a traumatic tracheal transection in whom we confronted difficulty in airway management after false intratracheal intubation. No associated injuries were seen in the patient, then, primary repair of the trachea was carried out under ventilatory support via percutaneous cardiopulmonary support system (PCPS). For a short period in the application of PCPS, the use of a heparin-coated circuit made systemic heparinization unnecessary during and after operation, and the outcome was satisfactory. In a carefully selected patient, ventilatory support via PCPS is useful.

Complete cervical tracheal transection due to blunt trauma

“…However, the continuity of the airway was barely maintained by the mediastinal and peritracheal connective tissue and the patient could be oxygenated. Intact peritracheal tissue may provide a life‐saving conduit for gas exchange through the disruption, as reported previously …”

“…In our case, fiberoptic bronchoscopy was used to direct the ETT safely into the distal tracheal segment, thus avoiding extratracheal intubation. However, in other reports, the ETT could not be guided to the lumen of the distal tracheal segment; in these circumstances, extracorporeal membrane oxygenation is performed …”

Transglottic high frequency jet ventilation for management of laryngeal fracture associated with air bag deployment injury

“…Not all patients are good candidates for awake tracheostomy. In such patients, a variety of techniques have been described, including inhalational induction with sevoflurane followed by tracheostomy [8] and brief cardiopulmonary bypass [9]. Although such measures may be appropriate in select scenarios, they are techniques that are difficult to incorporate into standard practice.…”

Clinical features and management of closed injury of the cervical trachea due to blunt trauma

“…If necessary, emergency intubation or tracheotomy should be performed [8,9]. Hemostasis should be achieved, and vital signs should be stabilized.…”