2022 Volume 29 Issue 4 Pages 275-279
Prompt tracheal stenting is a life-saving measure for patients with advanced airway stenosis. A 70s-year-old man was brought to the emergency room because of severe airway stenosis due to compression of the trachea by a posterior mediastinal tumor. The emergency physician requested the intensivist to intubate the patient. However, computed tomography of the site of stenosis revealed that safe intubation would not be possible for the patient. The respiratory physician, cardiovascular surgeon, and clinical engineer decided to immediately perform veno venous extracorporeal membrane oxygenation (ECMO) to remove blood from the femoral vein and deliver it to the internal jugular vein. After the stent insertion was prepared, the patient was transferred to the operating room for tracheobronchial stent insertion. Intraoperatively, the tracheal stent was safely placed under general anesthesia and muscle relaxant administration without tracheal intubation by maintaining oxygenation while adjusting the ECMO flow rate. Postoperatively, endotracheal intubation was performed to confirm that adequate ventilation was feasible, and the patient was weaned off ECMO. The following morning, the patient was weaned off the ventilator and could be extubated. Prompt decision-making through multidisciplinary collaboration is important.
