Early ECMO Initiation as a Bridge for Central Airway Obstruction Patients Caused by Neck and Chest Tumors to Emergency Surgery Operations

Abstract

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.