The difficult airway: cardiopulmonary bypass--the ultimate solution.
BACKGROUND
Large, compressive thyroid masses are usually removed as an elective procedure. Rarely is a patient's condition allowed to progress to severe respiratory distress before surgical intervention is recommended. When allowed to progress, management of the airway can be problematic.


METHODS
A case report of a patient with a neglected thyroid lymphoma is presented.


RESULTS
The natural progression of the disease, leading to impending airway collapse, necessitated emergency management of the airway. Due to supraglottic edema and a large neck mass, traditional methods of securing the airway were not feasible. Initiation of femoral-femoral cardiopulmonary bypass, under local anesthesia, ensured adequate oxygenation and allowed a controlled tracheotomy to be performed.


CONCLUSIONS
The result obtained suggests that this approach provides a safe solution for airway control when intubation or a surgically created airway is either unsuccessful or too hazardous.
Belmont
M J
MJ
Department of Otolaryngology-HNS, State University of New York at Buffalo, Buffalo General Hospital, 14203, USA.
Wax
M K
MK
DeSouza
F N
FN
D000368:Aged; D000402:Airway Obstruction / Q000209:etiology*; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000150:complications* / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000150:complications* / Q000601:surgery*; D014140:Tracheotomy