Perioperative extracorporeal membrane oxygenation for tracheal reconstruction in congenital tracheal stenosis

The management of a critical airway in infants and toddlers with congenital tracheal stenosis (CTS) continues to be an enormous challenge to the surge on. Until recently, this condition often proved fatal. Improvements in surg ical techniques, anesthetic management, and postoperative critical care hav e resulted in successful outcomes in children not long ago considered untre atable. However, issues such as the best operative approach and the optimal perioperative management are still unresolved. The diagnosis of CTS, often delayed, must be considered in any infant with strider, wheezing, cyanosis , or recurrent episodes of pneumonia. Associated anomalies are the rule, in cluding frequently vascular rings and rarely pulmonary agenesis. These defe cts can be repaired with conventional ventilatory support under cardio-pulm onary bypass, or using extracorporeal membrane oxygenation (ECMO). We repor t our experience in which ECMO was used to support two patients with CTS du ring the perioperative period. ECMO proved to be both safe and practical, a llowing unrushed, precise repair of the tracheal stenosis and providing bri ef postoperative support. Perioperative outcomes were excellent, although o ne of our patients died months after the repair. A review of the literature and our experience in which ECMO was used to provide cardiopulmonary suppo rt during repair of CTS showed uniformly successful perioperative outcomes.