Clinical management of airway stenosis is often challenging. We report our experience of performing semi-emergent tracheostomy under extracorporeal membrane oxygenation (ECMO) support in a patient with subglottic airway stenosis. A 33-year-old female patient was admitted with a 3-months' history of dyspnea. She had a breathy voice and mild stridor. Fiberoptic laryngoscopy and CT revealed subglottic stenosis caused by an unknown lesion destroying a part of the cricoid cartilage. Although securing of the airway was required, there was a risk of CVCI (cannot ventilate and cannot intubate) when attempting tracheal intubation. Furthermore, even we, as otolaryngologists, found it extremely difficult to safely perform tracheostomy under local anesthesia, because of the possibility of the lesion affecting the trachea below the cricoid cartilage, presence of a diffuse swollen thyroid gland due to Basedow disease, and moderate obesity. Therefore, we planned to perform tracheostomy under ECMO for maintaining oxygenation. Subsequently, after the anesthesiologist managed to successfully intubate the patient, ECMO was withdrawn and tracheostomy was uneventfully performed under general anesthesia. We consider airway management under ECMO to be useful in patients in whom both tracheal intubation and tracheostomy are considered high risk.
- Clinical management of airway stenosis
- Extracorporeal circulation
- Subglottic stenosis