THE DIFFICULT AIRWAY - CARDIOPULMONARY BYPASS - THE ULTIMATE SOLUTION

Background. Large, compressive thyroid masses are usually removed as a n elective procedure. Rarely is a patient's condition allowed to progr ess to severe respiratory distress before surgical intervention is rec ommended. When allowed to progress, management of the airway can be pr oblematic. Methods. A case report of a patient with a neglected thyroi d lymphoma is presented. Results. The natural progression of the disea se, leading to impending airway collapse, necessitated emergency manag ement of the airway. Due to supraglottic edema and a large neck mass, traditional methods of securing the airway were not feasible. Initiati on of femoral-femoral cardiopulmonary bypass! under local anesthesia, ensured adequate oxygenation and allowed a controlled tracheotomy to b e performed. Conclusions. The result obtained suggests that this appro ach provides a safe solution for airway control when intubation or a s urgically created airway is either unsuccessful or too hazardous. (C) 1998 John Wiley & Sons, Inc.