Elective extracorporeal membrane oxygenation: An improved perioperative technique in the treatment of tracheal obstruction

The surgical management of children with tracheal stenosis and obstruction is complicated by the perioperative needs of pressure ventilation and indwe lling endotracheal tubes. These factors predispose to surgical failure and anastomotic breakdown, restenosis, and pneumomediastinum. The use of extrac orporeal membrane oxygenation (ECMO) to manage ventilation during tracheal repair allows better visualization at the surgical site and obviates the ne ed for indwelling endotracheal tubes and high-pressure ventilation. Six chi ldren were treated with elective ECMO at a tertiary care hospital. All 6 un derwent successful surgical repair, and 4 of the 6 were ultimately extubate d. There were no significant complications at the surgical site. There was 1 death from postoperative complications, and 2 patients required tracheoto my. One tracheotomy was performed for upper airway obstruction secondary to retrognathia, and this patient was subsequently decannulated. Medical comp lications were confined to 2 patients and included sepsis, hyperbilirubinem ia, seizure disorder, renal failure, intracranial hemorrhage, and hydroceph alus. Elective ECMO provides a reliable perioperative technique for airway management of children with tracheal stenosis or obstruction. This techniqu e offers the advantage of improved visibility at the operative site and eli minates the need for high-pressure ventilation, thereby likely reducing the risk of perioperative morbidity.