CASE REPORT
Year : 2022  |  Volume : 16  |  Issue : 1  |  Page : 120-123

Management of refractory hypoxemia during elective extracorporeal support for complex tracheal resection


Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA

Correspondence Address:
Neal S Gerstein
Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine - MSC 10 6000, Albuquerque - 87106, NM
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.sja_265_21

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Venovenous extracorporeal membrane oxygenation (VV-ECMO) is increasingly used in managing challenging airway and thoracic cases with complex airway manipulations. We present a case of a complex tracheal resection needing prolonged apnea times for which VV-ECMO was electively planned. Intraoperatively, the team was faced with continued oxygen desaturations during periods of apnea. With an algorithmic approach to troubleshooting hypoxemia, several factors were taken into consideration. Apneic oxygenation was applied to the open tracheal segment. Despite an open airway, the applied apneic oxygenation facilitated oxygenation to the portion of the cardiac output that was being shunted through the lungs as opposed to the VV-ECMO circuit, enabling uninterrupted completion of the surgical resection and reanastomosis.


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