Urgent Tracheal Resection and Reconstruction Assisted by Temporary Cardiopulmonary Bypass: a Case Report

Abstract

Severe tracheal stenosis can not only cause critical medical problems such as severe shortness of breath, hypoxia, and even orthopnea, but also impose overwhelming challenges on the physicians, particularly the anesthesiologist. Life-threatening airway obstruction can make the patient's gas exchange extremely difficult.Though several options could be offered regarding the treatment of tracheal stenosis, normally, tracheal resection and following reconstruction is the first choice for severe airway stenosis. Successful surgical intervention relies on the close communication and cooperation between surgeons and anesthesiologists. In these cases, airway management is the top issue for the anesthesiologist, and the level of difficulty varies with stenosis location, severity of stenosis, and surgical technique. Extracorporeal membrane oxygenation (ECMO), or cardiopulmonary bypass (CPB), is rarely utilized for the surgery, but for those impossible airways due to nearly complete tracheal obstruction, ECMO or CPB could be the final choice for anesthesiologists. Here we report a case of successful urgent airway management for tracheal resection and reconstruction assisted by temporary CPB.

Bronchoscopy-guided intervention therapy with extracorporeal membrane oxygenation support for advanced cancer metastasis to the central airway

“…Fan et al [ 21 ] proposed that for patients with larger tumors occupying >70% of the lumen, temporary extracorporeal circulation must be used for surgical treatment. Gao et al [ 22 ] posit that extracorporeal circulation (CPB) should be used for the surgical treatment of tracheal tumors. However, CPB is more likely to increase postoperative bleeding and potential complications such as liver and kidney dysfunction, and the establishment of CPB technology is difficult and time-consuming, causing great trauma to patients and more complications in later infections, so it is not an ideal support method.…”

Management of Anesthesia under Extracorporeal Cardiopulmonary Support in an Infant with Severe Subglottic Stenosis

“…CPB and ECMO, both of which can be a life-saving maneuver for near or total occlusion of the airway, have been used for tracheal surgery [13–16]. Tracheostomy in infants with subglottic stenosis is a challenging approach, even for experienced otolaryngologists [17, 18].…”

Peripheral Cardiopulmonary Bypass under Local Anaesthesia for Tracheal Tumour Resection

“…This technique provides a method of maintaining gas exchange allowing time for resection and good surgical access even if complete tracheal obstruction occurs [4,7]. CPB is well described as an adjunct to tracheal tumour resection but is rarely instituted under local anaesthetic [8,9]. Two cases of thyroid lymphoma causing near complete airway obstruction have been reported where the use of a portable cardiopulmonary bypass circuit was used in one case [10] and conventional femoral-femoral cardiopulmonary bypass under local anaesthesia in the other to assist the airway management and provide a safe operation [11].…”