The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

ECMO: A NOVEL TREATMENT FOR TRACHEAL DEHISCENCE AFTER SLIDE TRACHEOPLASTY

Jenni Raake1,2, Brandy Seger2,6, BethAnn Johnson1, Pirooz Eghtesady3, Peter Manning3, Mike Rutter4, Paul Boesch5, Amanda Woodard1, Ranjit Chima6; 1Cardiac ICU, Cincinnati Children’s Hospital, Cincinnati, OH; 2Respiratory Care, Cincinnati Children’s Hospital, Cincinnati, OH; 3Cardiothoracic Surgery, Cincinnati Children’s Hospital, Cincinnati, OH; 4Otolaryngology, Cincinnati Children’s Hospital, Cincinnati, OH; 5Pulmonary Medicine, Cincinnati Children’s Hospital, Cincinnati, OH; 6Pediatric ICU, Cincinnati Children’s Hospital, Cincinnati, OH

Introduction: Long segment congenital tracheal stenosis is characterized by complete tracheal rings. Surgical intervention is required during infancy to optimize outcomes. Complications from surgery can include mucus plugging, airway trauma, dehiscence at the surgical site, and death. Case Summary A 5 week with long segment congenital tracheal stenosis (LSCTS) underwent a slide tracheoplasty. She failed extubation on post op day (POD) 2, she was reintubated. A bronchoscopy revealed thick secretions and tracheal edema. She required daily periods of manual ventilation and on POD 5 she had an acute respiratory event requiring CPR. Bronchoscopy revealed surgical site dehiscence. She was placed on ECMO, and electively extubated to avoid further airway trauma. On ECMO day 5, a flexible bronchoscopy revealed airway healing. She was reintubated and placed on low ventilator settings. On POD 14, she was transitioned to HFOV, decannulated on POD 19, and transitioned to conventional ventilation on POD 24. She was successfully extubated on POD 39, transferred out of the ICU on POD 43, and discharged to the referring facility on POD 55. Discussion LSCTS options include tracheal autograft, tracheal resection, or slide tracheoplasty. Surgeons “leak test” the tracheal anastomosis at 35cm H2O. During manual ventilation, there may have been periods when ventilation pressures that exceeded 35 cm H2O. Tracheal dehiscence is rare and life threatening. Options were limited for this patient, and ECMO allowed her trachea to heal. Routine use of ECMO in tracheal surgery has been described. ECMO facilitated airway healing. We went a step further and extubated her once she was on ECMO. Isolated reports exist of pediatric and adult patients being extubated on ECMO. Our report is the first where such a strategy was utilized following slide tracheoplasty. Our lung recruitment strategy involved the use of conventional mechanical ventilator followed by HFOV. After the patient was decannulated we continued using a conservative ventilation strategy, keeping her on HFOV for 5 days before transitioning to conventional ventilation. Sponsored Research - None

Figure on Left: Tracheal Wall Erosion on POD 5. Figure on Right: Complete Airway Healing on POD 27