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Liang L, Su S, He Y, Peng Y, Xu S, Liu Y, Zhou Y, Yu H. Early extracorporeal membrane oxygenation as bridge for central airway obstruction patients caused by neck and chest tumors to emergency surgery. Sci Rep 2023; 13:3749. [PMID: 36878956 PMCID: PMC9988871 DOI: 10.1038/s41598-023-30665-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Central airway obstruction caused by neck and chest tumors is a very dangerous oncological emergency with high mortality. Unfortunately, there is few literature to discuss an effective way for this life-threating condition. Providing effective airway managements, adequate ventilation and emergency surgical interventions are very important. However, traditional airway managements and respiratory support has only limited effect. In our center, using extracorporeal membrane oxygenation (ECMO) as a novel approach to manage patient with central airway obstruction caused by neck and chest tumors has been adopted. We aimed to show the feasibility: using early ECMO to manage difficult airway, provide oxygenation and support surgical procedure for patients with critical airway stenosis caused by neck and chest tumors. We designed a single-center, small sample size retrospective study based on real-world. We identified 3 patients with central airway obstruction caused by neck and chest tumors. ECMO was used to ensure adequate ventilation to emergency surgery. Control group cannot be established. Because traditional manner very likely led to death of such patients. Details of clinical characteristics, ECMO, surgery and survival outcomes were recorded. Acute dyspnea and cyanosis were the most frequent symptoms. All patients (3/3) showed descending arterial partial pressure of oxygen (PaO2). Computed tomography (CT) revealed severe central airway obstruction caused by neck and chest tumors in all cases (3/3). All patients (3/3) had definite difficult airway. All cases (3/3) received ECMO support and emergency surgical procedure. Venovenous ECMO was the common mode for all cases. 3 patients weaned off ECMO successfully without any ECMO-related complications. Mean duration of ECMO was 3 h (range: 1.5-4.5 h). Under ECMO support, difficult airway management and emergency surgical procedure were finished successfully for all cases (3/3). The mean ICU stay was 3.3 days (range: 1-7 days), and the mean general ward stay was 3.3 days (range: 2-4 days). Pathology demonstrated the tumor dignity for 3 patients including 2 malignant cases and 1 benign case. All patients (3/3) were discharged from hospital successfully. We showed that early ECMO initiation was a safe and feasible approach to manage difficult airway for patients with severe central airway obstruction caused by neck and chest tumors. Meanwhile, early ECMO initiation could ensure security for airway surgical procedure.
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Affiliation(s)
- LianJing Liang
- Emergency Medicine Department, Emergency Medical Laboratory, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - ShiTong Su
- Emergency Medicine Department, Emergency Medical Laboratory, West China Hospital, Sichuan University, Chengdu, 610041, China.,Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - YaRong He
- Emergency Medicine Department, Emergency Medical Laboratory, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - YaLan Peng
- Medical General Department of Medical Affairs Division, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - ShuYun Xu
- Emergency Medicine Department, Emergency Medical Laboratory, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yang Liu
- Day Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - YaXiong Zhou
- Emergency Medicine Department, Emergency Medical Laboratory, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - HaiFang Yu
- Emergency Medicine Department, Emergency Medical Laboratory, West China Hospital, Sichuan University, Chengdu, 610041, China.
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