Treatment of tracheal stenosis with extracorporeal membrane oxygenation support in infants and newborns

Abstract

Tracheal stenosis in children is a challenge for the healthcare team, since it is a rare disease. Patients usually have other clinical comorbidities, mainly previous cardiac surgical interventions. This retrospective single‐center study included infants with tracheal stenosis (congenital or acquired) operated between 2016 and 2020 on venoarterial extracorporeal membrane oxygenation (VA ECMO). Five patients were operated and the median age of detection of the tracheal disease was 3.7 months, and the median age at the operation was 5 months. All patients had associated cardiac anomalies. Four patients had congenital tracheal stenosis; two with associated pig bronchus. One patient had acquired subglottic stenosis with concomitant stenosis at the carina. After the operation, the patients were referred to ICU on ECMO with an open chest. Minor ECMO‐related complications occurred in two patients (hemothorax and wound infection). All patients required endoscopic evaluation during the postoperative care; median of 3.2 procedures. Two patients are currently in follow‐up and three have died. Slide tracheoplasty with VA‐ECMO can be successfully performed in infants with prior cardiac surgery. Nevertheless, a difficult postoperative course should be anticipated, with possible prolonged ECMO use, readmissions, and higher morbidity and mortality than in children with tracheal stenosis alone.

Case Report: ECMO-assisted tracheal reconstruction in a 30-week-gestation preterm infant with tracheal stenosis

“…When not involving the heart, our preferred method of extracorporeal life support is ECMO. Therefore, we have implemented an innovative approach of utilizing ECMO for oxygenation as opposed to endotracheal intubation, resulting in clearer surgical field and shorter operating time ( 6 ). Over the past two years, we have performed multiple successful ECMO-assisted tracheal tumor resections with tracheal reconstruction, thereby accumulating extensive experience in this field ( 7 ).…”

Neonatal Airway Abnormalities

“…In patients with more severe stenosis, surgical management is recommended. Slide tracheoplasty performed on extracorporeal membranous oxygenation is a highly specialized procedure that can provide a patent airway [ 59 ].…”

Isolated Congenital Tracheal Stenosis in a 2-Year-Old Female: A Case Report

“…A signi cant proportion of patients present with various respiratory symptoms of differing severity, with a substantial number necessitating urgent hospitalization following episodes of collapse at home, during which parental resuscitation is often imperative (9)(10)(11)(12). The management of CTS can be exceptionally challenging, with di culties in intubation and ventilation, at times necessitating the use of extracorporeal membrane oxygenation (ECMO) for respiratory support (13)(14)(15). Hence, the early identi cation and meticulous management of CTS are critical for preventing long-term respiratory complications and improving patient outcomes.…”