Author(s)
Koji Saida, MD
Shogo Shinohara, MD PhD
Tetsuhiko Michida, MD
Shinji Takebayashi, MD PhD
Keizo Fujiwara, MD
Yasushi Naito, MD PhD
Affiliation(s)
Kobe City Medical Center General Hospital
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to acquire knowledge of the tracheostomy with a concomitant use of veno-venous extracorporeal membrane oxygenation (V-V ECMO). This is a safety way to perform a tracheostomy to the patient with severe airway obstruction and/or hypoxemia. Objectives: It is challenging and sometimes life threatening to secure airway of patients whose upper airway is obstructed by large tumors and other causes. The veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a technique to oxygenate the venous blood using cardiopulmonary bypass in respiratory failure. We evaluate the indication of a concomitant use of V-V ECMO in tracheostomy by reviewing 4 cases in our hospital. Study Design: Case series and literature review. Methods: Retrospective review of 4 cases inserted V-V ECMO before or after tracheotomy to prevent or resolve critical hypoxemia from April 2016 to February 2017. Results: The patients consisted of 2 males and 2 females, age ranged 61 to 74. All cases had a symptom of dyspnea with malignancy (lung cancer, laryngeal cancer, esophageal cancer and malignant lymphoma) which severely obstructed their airway. In 3 cases, V-V ECMO was activated before tracheostomy. In 1 case, we emergently inserted V-V ECMO after tracheostomy due to endobronchial tumor embolism. The median time to activate V-V ECMO was 40.5 (40-78) minutes and the median time to perform tracheostomy was 30.5 (7-57) minutes. No severe sequelae occurred associated with hypoxemia and V-V ECMO surgery in all cases. However, an anatomic disorientation by large tumor and the heparinization during V-V ECMO prolonged the operation times in 2 cases (46 and 57 minutes). Conclusions: Although V-V ECMO is costly and operable facilities are limited, we should consider a concomitant use of V-V ECMO before attempting to secure airway to a patient who is highly likely to suffocate during intubation or tracheostomy.