Anesthetic Strategies in Critical Tracheal Stenosis: A Case Report on a Novel Extracorporeal Membrane Oxygenation-assisted Stenting Approach

Ramesh Varadarajan; Aparna Lohanathan; Gunaseelan K Ramalingam; Rajkumar Nagarathinam

doi:10.5005/jaypee-journals-11011-0026

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Anesthetic Strategies in Critical Tracheal Stenosis: A Case Report on a Novel Extracorporeal Membrane Oxygenation-assisted Stenting Approach

Ramesh Varadarajan, Aparna Lohanathan, Gunaseelan K Ramalingam, Rajkumar Nagarathinam

Keywords : Airway obstruction, Case report, Critical tracheal stenosis, Difficult airway, Extracorporeal membrane oxygenation-assisted, Rigid bronchoscopy, Venoarterial extracorporeal membrane oxygenation

Citation Information : Varadarajan R, Lohanathan A, Ramalingam GK, Nagarathinam R. Anesthetic Strategies in Critical Tracheal Stenosis: A Case Report on a Novel Extracorporeal Membrane Oxygenation-assisted Stenting Approach. Indian J ECMO 2024; 2 (1):3-6.

DOI: 10.5005/jaypee-journals-11011-0026

License: CC BY-NC 4.0

Published Online: 19-06-2024

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Abstract

Aim and background: Tracheal stenosis, arising from intubation-related trauma, poses challenges in management, particularly during rigid bronchoscopy (RB). This case explores the effective use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) during tracheal stent placement for central airway obstruction. Case description: A 44-year-old male chronic obstructive pulmonary disease (COPD) patient with postcardiac arrest presented with worsening respiratory symptoms. Diagnosed with postintubation tracheal stenosis (PITS), initial flexible bronchoscopy attempts failed. Rigid bronchoscopy with tracheal stenting was planned. Due to comorbidities, VA-ECMO was initiated before the procedure. Upon arrival in the operating room (OR), ECMO was initiated under local anesthesia. Cannulation involved a 29 Fr venous cannula and a 17 Fr arterial cannula. Systemic anticoagulation was maintained. Anesthesia was induced, and the patient was intubated with a 4.5-size rigid bronchoscope. Stenotic segment dilation and 12-mm silicone tracheal stent placement were performed. Postprocedure, ECMO was gradually weaned, and the patient maintained stable hemodynamics. The patient underwent successful stenting with ECMO support, resulting in improved oxygenation and obstruction resolution. Conclusion: Tracheal stenosis poses challenges in therapeutic strategies, with stenting carrying inherent risks. In this case, VA-ECMO provided continuous oxygenation during the procedure, aligning with recent studies favoring its use in central airway obstruction. The successful application of VA-ECMO in our case supports its safety and effectiveness. Clinical significance: This case underscores the successful utilization of VA-ECMO in managing PITS during tracheal stenting. The decision to employ ECMO should involve a multidisciplinary approach. Acknowledging potential complications, our findings emphasize the need for further research. Integrating VA-ECMO in tracheal stenosis interventions ensures collaborative airway management, ensuring patient safety and optimal outcomes.

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De S, De S. Post-intubation tracheal stenosis. Indian J Crit Care Med 2008;12(4):194–197. DOI: 10.4103/0972-5229.45081.
Putz L, Mayné A, Dincq AS. Jet ventilation during rigid bronchoscopy in adults: A focused review. Biomed Res Int 2016;2016:4234861. DOI: 10.1155/2016/4234861.
Chao YK, Liu YH, Hsieh MJ, et al. Controlling difficult airway by rigid bronchoscope—An old but effective method. Interact Cardiovasc Thorac Surg 2005;4(3):175–179. DOI: 10.1510/icvts.2004. 098038.
Shiraishi T, Shirakusa T, Hiratsuka M, et al. Stenting for critical airway stenosis under percutaneous cardiopulmonary support. Jpn J Thorac Cardiovasc Surg 2004;52(12):592–596. DOI: 10.1007/s11748-004- 0032-0.
Marasco SF, Lukas G, McDonald M, et al. Review of ECMO (extracorporeal membrane oxygenation) support in critically ill adult patients. Heart Lung Circ 2008;17(Suppl. 4):S41–S47. DOI: 10.1016/j.hlc.2008.08.009.
Meyer S, Dincq A-S, Pirard L, et al. Bronchotracheal stenting management by rigid bronchoscopy under extracorporeal membrane oxygenation (ECMO) support: 10 years of experience in a tertiary center. Can Respir J 2021;2021:8822591. DOI: 10.1155/2021/8822591.
Wu H, Zhuo K, Cheng D. Extracorporeal membrane oxygenation in critical airway interventional therapy: A review. Front Oncol 2023;13:1098594. DOI: 10.3389/fonc.2023.1098594.
Hong Y, Jo K-W, Lyu J, et al. Use of venovenous extracorporeal membrane oxygenation in central airway obstruction to facilitate interventions leading to definitive airway security. J Crit Care 2013;28(5):669–674. DOI: 10.1016/j.jcrc.2013.05.020.

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