Bridge to recovery using extracorporeal membrane oxygenation for critical tracheal stenosis complicating refractory bronchospasm.

An acute upper airway obstruction can be caused by symptomatic postintubation or tracheostomy tracheal stenosis, and this serious condition often requires surgery, interventional bronchoscopy therapy (such as balloon dilatation), laser therapy, electrocautery, and stent placement. However, these treatments may not be feasible due to severe hypoxemia, ventilator failure, or shock and cardiac arrest, necessitating an advanced plan to establish airway patency, especially in an emergency department (ED) setting. Previous reports have demonstrated the feasibility and efficacy of using extracorporeal membrane oxygenation (ECMO) for acute upper airway obstruction from various etiologies. Here, we report on a case of a 69-year-old woman with a history of repeated tracheal stent placement for postintubation tracheal stenosis who developed an acute tracheal obstruction from bloody clots after tracheostomy tube change, which was further complicated by severe bronchospasm. Oxygenation and ventilation were achieved via ED-initiated ECMO support. This case demonstrates how the rapid deployment of ECMO can be viable rescue therapy in the ED for a patient with acute tracheal obstruction.