Utilization of V-VECMO as a Backup for Patients with Large Multinodular Goiters Causing Extreme Tracheal Compression

Introduction:

Multinodular goiter (MNG) can be a challenging pathology owing to its large size and possible significant airway deviation and compression. To secure the airway in such cases, awake fiberoptic intubation is recommended, but limitations include patient distress and varying success owing to operator skill. Therefore, veno-venous (V-V) Extracorporeal membrane oxygenation (ECMO) can be used as a backup for patients with severe tracheal stenosis due to a large MNG.

Materials and Methods:

We describe our technique for V-V ECMO cannulation followed by thyroidectomy and successful intubation. We also include four patients requiring prophylactic V-V ECMO for a large MNG presenting with extreme airway compression.

Results:

Four patients with severe critical tracheal stenosis underwent thyroidectomy at Emory University requiring prophylactic ECMO cannulation. Two patients required only wire access and were successfully intubated. The other two patients required V-V ECMO and thyroidectomy followed by fiberoptic intubation and bronchoscopy.

Technique.

(1)

Cardiac surgery places wire access using ultrasound guidance of the right and left femoral veins with fluoroscopy.

Conclusion:

Large MNG with severe tracheal stenosis pose a challenging problem for successful intubation. Awake fiberoptic intubation can be limiting as it is distressing to the patient, and its success depends on patient tolerance and operator skill. Patients with severe critical tracheal narrowing have no backup to failed awake fiberoptic or rigid bronchoscopy. Prophylactic V-V ECMO provides a solution for the difficult airway and requires a multidisciplinary approach.

Disclosure Statement: No financial disclosures or conflicts of interest.

Runtime of video: 5 mins 25 secs