title: Elective use of veno-venous extracorporeal membrane oxygenation and high-flow nasal oxygen for resection of subtotal malignant distal airway obstruction.
abstract: We describe the use of peripheral veno-venous extracorporeal membrane oxygenation (VV ECMO) and high-flow nasal oxygen as procedural support in a patient undergoing debulking of a malignant tumour of the lower airway. Due to the significant risk of complete airway obstruction upon induction of anaesthesia, ECMO was established while the patient was awake, and was maintained without systemic anticoagulation to minimise the risk of intraoperative bleeding. This case illustrates that ECMO support with high-flow nasal oxygen can be considered as part of the algorithm for airway management during surgery for subtotal lower airway obstruction, as it may be the only viable option for maintaining adequate gas exchange.
authors.affiliation: Resident Medical Officer, Medical Training and Administration Unit, Royal Prince Alfred Hospital, Sydney, New South Wales.
authors.forename: Rkf
authors.initials: R
authors.lastname: Fung
authors.affiliation: Specialist Anaesthetist and Medical Perfusionist, Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales.
authors.forename: J
authors.initials: J
authors.lastname: Stellios
authors.affiliation: Head of Department, Cardiothoracic Surgery, Royal Prince Alfred Hospital, Bosch Professor of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales.
authors.forename: P G
authors.initials: PG
authors.lastname: Bannon
authors.affiliation: Head of Department, Ear, Nose and Throat Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales.
authors.forename: A
authors.initials: A
authors.lastname: Ananda
authors.affiliation: Head, Cardiothoracic Anaesthesia and Perfusion, Royal Prince Alfred Hospital, Clinical Associate Professor of Anaesthesia, Sydney Medical School, The University of Sydney, Sydney, New South Wales.
authors.forename: P
authors.initials: P
authors.lastname: Forrest
mesh_terms: D000368:Aged; D058109:Airway Management / Q000379:methods; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery*; D065426:Cytoreduction Surgical Procedures / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D008545:Melanoma / Q000473:pathology / Q000601:surgery; D010100:Oxygen / Q000008:administration & dosage*; D011659:Pulmonary Gas Exchange; D014134:Tracheal Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*
chemical_list: D010100:Oxygen
keywords: airway obstruction, decompression, surgical, extracorporeal membrane oxygenation, laryngoscopy