Extracorporeal Oxygenation Techniques in Adult Critical Airway Obstruction: A Review

Abstract

Extracorporeal life support has been increasingly utilized in different clinical settings to manage either critical respiratory or heart failure. Complex airway surgery with significant or even total perioperative airway obstruction represents an indication for this technique to prevent/overcome a critical period of severe hypoxaemia, hypoventilation, and/or apnea. This review summarizes the current published scientific evidence on the utility of extracorporeal respiratory support in airway obstruction associated with hypoxaemia, describes the available methods, their clinical indications, and possible limitations. Extracorporeal membrane oxygenation using veno-arterial or veno-venous mode is most commonly employed in such scenarios caused by endoluminal, external, or combined obstruction of the trachea and main bronchi.

Cryodebulking to Relieve Critical Airway Narrowing Due to a Central Airway Tumor at the Carina: A Case Report and Literature Review

“…Due to the late presentation, effective management is generally aimed at palliative care rather than with curative intent [3,4]. Patients presenting with respiratory failure due to critical airway stenosis have traditionally been treated with thermo-ablative techniques (electrocautery, laser, and argon plasma coagulation (APC)) followed by metallic or synthetic stent placement, with or without extracorporeal membrane oxygenation (ECMO) as a stop-gap until reestablishing a patent airway [3,5]. Our case underscores the efficacy of cryorecanalization as an immediate treatment in alleviating critical stenosis in a patient who presented with respiratory failure due to a large central airway tumor at the level of the carina.…”