Using Extracorporeal Membrane Oxygenation for COVID-Positive Urgent Tracheostomy
Otolaryngology - Head and Neck Surgery
; 167(1 Supplement):P226, 2022.
Article
in English
| EMBASE | ID: covidwho-2064405
ABSTRACT
Introduction:
Extracorporeal membrane oxygenation (ECMO) can be used during difficult airway surgery because it provides an unobstructed operative field while ensuring adequate oxygenation without need for ventilation. We present a case of utilizing ECMO to perform urgent tracheostomy on a COVIDpositive patient with a large oropharyngeal mass causing critical airway narrowing. Method(s) A 62-year-old man presented with 6 months of worsening dyspnea. Computed tomography imaging and flexible laryngoscopy showed a large oropharyngeal mass extending into the nasopharynx and larynx causing critical airway narrowing and severely distorted upper airway anatomy. Traditional methods to secure the airway including transnasal vs transoral intubation vs awake tracheostomy were considered inadequate due to tumor location/friability, trismus, inability to lie flat, and unclear tracheal landmarks on palpation. In addition, on the day of surgery, the patient tested positive for COVID. We decided ECMO was the safest method to safely perform tracheostomy while minimizing COVID aerosolization. Result(s) The thoracic surgery team proceeded with bifemoral cannulation, and ECMO was initiated in less than 30 minutes. Standard tracheostomy was performed, and biopsies of the oropharyngeal mass were obtained. The patient was weaned off ECMO after <1 hour and awakened without any issues. There were no complications from bi-femoral venous access. Conclusion(s) Multiple methods to secure this patient's difficult airway were considered. Fiber-optic nasal intubation would require navigating the bronchoscope around the large tumor partially obstructing the nasopharynx and larynx. Awake tracheostomy was considered risky due to his large neck circumference, significant coughing episodes, and inability to lay supine. Both of these options would also be associated with high levels of COVID aerosolization. The use of ECMO allowed for apneic tracheostomy while minimizing the risk of COVID infection to all operating room personnel. In the era of COVID, ECMO is an unconventional but powerful tool that should be added to the armamentarium of highrisk airway surgery.
adult; aerosol; ambulatory surgery; apnea; bronchoscope; cannulation; case report; clinical article; complication; computer assisted tomography; conference abstract; coronavirus disease 2019; coughing; difficult airway management; dyspnea; extracorporeal oxygenation; fiber optics; flexible laryngoscopy; human; intubation; larynx; male; middle aged; nasopharynx; neck circumference; neoplasm; operating room personnel; palpation; surgery; thorax surgery; tracheostomy; trismus; upper respiratory tract; wakefulness
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Language:
English
Journal:
Otolaryngology - Head and Neck Surgery
Year:
2022
Document Type:
Article
Similar
MEDLINE
...
LILACS
LIS