Extracorporeal membrane oxygenation for repair of tracheal injury during transhiatal esophagectomy

Abstract

Extracorporeal Membrane Oxygenation (ECMO) for repair of tracheal injury during transhiatal esophagectomy Tracheal injury is a rare but potentially fatal complication of esophagectomies requiring prompt recognition and treatment. We describe a case of tracheal injury recognized in the operative period of an open transhiatal esophagectomy for squamous cell carcinoma of the mid to distal esophagus. When injury was discovered, attempts to improve oxygenation and ventilation by conventional methods were unsuccessful. Therefore, peripheral ECMO was used to support oxygenation during the tracheal defect repair. The use of ECMO for the repair of a tracheal injury during esophagectomy is very uncommon but, in our case, provided adequate oxygenation and ventilation while the surgeon repaired the injury and the patient was able to be promptly weaned from ECMO support and extubated not long after.

Treatment of Tracheobronchial Injuries

“…Bronchoscopy is essential to prevent the formation of a false track or worsening the extent the tracheal tear. 49 If a patient fails mechanical ventilatory support because of the underlying injury, advanced life support with extracorporeal membrane oxygenation may be required as a bridge to recovery 50 and/or definitive surgical intervention [51][52][53][54] (Fig 4).…”

Extracorporeal membrane oxygenation in trauma: A single institution experience and review of the literature

“…24,25 In trauma, VA ECMO offers the potential advantage of temporary circulatory quiescence to allow for repair of complex injuries. [26][27][28][29][30][31][32] Similar to VV bypass for complex hepatic trauma, flows can be adjusted to account for blood loss and allow for the repair of venous injuries. 33 VA ECMO can support the failing heart in patients with pre-existing cardiac disease, 34 as well as provide neuroprotection following cardiac arrest.…”

Extracorporeal membrane oxygenation for management of iatrogenic distal tracheal tear

“…The role of ECMO support for tracheal complications comes from case reports of tracheal stenosis, massive hemoptysis, and tracheal injury not related to intubation. 3 , 5 , 6 , 7 Unique to this case, the underlying lung disease (adenovirus pneumonia) and distal injury necessitated emergent ECMO to correct severe hypercarbia and acidosis. Femoral-femoral veno-venous access allows for fast cannulation without ultrasound or transesophageal echocardiography.…”