Elective Extracorporeal Membrane Oxygenation: An Improved Perioperative Technique in the Treatment of Tracheal Obstruction

The surgical management of children with tracheal stenosis and obstruction is complicated by the perioperative needs of pressure ventilation and indwelling endotracheal tubes. These factors predispose to surgical failure and anastomotic breakdown, restenosis, and pneumomediastinum. The use of extrac...

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Bibliographic Details
Published in:Annals of otology, rhinology & laryngology rhinology & laryngology, 2001-03, Vol.110 (3), p.205-209
Main Authors: Connolly, Kieran M., McGuirt, William F.
Format: Article
Language:English
Subjects:
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Child
Emergency and intensive respiratory care
Extracorporeal Membrane Oxygenation
Female
Humans
Infant
Infant, Newborn
Intensive care medicine
Male
Medical sciences
Non tumoral diseases
Otorhinolaryngology. Stomatology
Preoperative Care
Tracheal Stenosis - therapy
Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology
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Summary:The surgical management of children with tracheal stenosis and obstruction is complicated by the perioperative needs of pressure ventilation and indwelling endotracheal tubes. These factors predispose to surgical failure and anastomotic breakdown, restenosis, and pneumomediastinum. The use of extracorporeal membrane oxygenation (ecmo) to manage ventilation during tracheal repair allows better visualization at the surgical site and obviates the need for indwelling endotracheal tubes and high-pressure ventilation. Six children were treated with elective ecmo at a tertiary care hospital. All 6 underwent successful surgical repair, and 4 of the 6 were ultimately extubated. There were no significant complications at the surgical site. There was 1 death from postoperative complications, and 2 patients required tracheotomy. One tracheotomy was performed for upper airway obstruction secondary to retrognathia, and this patient was subsequently decannulated. Medical complications were confined to 2 patients and included sepsis, hyperbilirubinemia, seizure disorder, renal failure, intracranial hemorrhage, and hydrocephalus. Elective ecmo provides a reliable perioperative technique for airway management of children with tracheal stenosis or obstruction. This technique offers the advantage of improved visibility at the operative site and eliminates the need for high-pressure ventilation, thereby likely reducing the risk of perioperative morbidity.
ISSN:0003-4894
1943-572X
DOI:10.1177/000348940111000301