Postoperative extracorporeal membrane oxygenation can successfully support patients following upper airway reconstruction.

Abstract

Patients requiring intensive upper airway reconstruction are anatomically restricted in terms of the respiratory support they can receive. While intraoperative extracorporeal membrane oxygenation (ECMO) has been effectively utilized, little has been shown regarding the utility of ECMO for long-term support in these patients. We demonstrate how a patient with tongue and hypopharyngeal squamous cell carcinoma that necessitated upper airway reconstruction was supported with veno-venous (VV) ECMO due to postoperative respiratory failure and an inability to maintain a stable airway. By initiating VV ECMO, we were able to decrease positive pressure ventilation and FiO₂ , thereby minimizing ventilator-associated trauma and irritation to facilitate wound healing. Over time, ventilatory support was increased in parallel with decreasing ECMO support, allowing discharge to rehabilitation after 74 days of ECMO. ECMO can effectively support patients with ongoing respiratory requirements following upper airway reconstruction when standard ventilatory techniques are inadequate or not feasible.