2020 FSA Posters

P045: WHEN ENT CAN'T FIND THE TRACHEA, ECMO SAVES THE DAY
Arina Ghosh, MD; Jackson Memorial Hospital

An 82 year old male with multiple comorbidities and history of tracheostomy complicated by subglottic stenosis presented in airway distress. The patient was transported to the OR with a 20G thumb peripheral IV and a laryngeal mask airway. An awake emergent tracheostomy was performed, and a 6.0ETT was placed in the airway. The ETT was able to pass the stenosis, and initially we were able to ventilate the patient. Subsequently in order to obtain a secure airway, the ETT was removed for distal 6.0 XLT. Afterwards, we were unable to ventilate the patient and unable to obtain etCO2. Multiple attempts were made by ENT to pass a tracheostomy tube, ETT, and bronchoscope to aid in resecuring the airway, however all attempts were unsuccessful at yielding ventilation. Anesthesia and Surgery made the decision to place the patient on VV-ECMO as the airway could not be secured. After the establishment of ECMO, ENT returned with Cardiothoracic surgery to explore the trachea, finding it to be deep within the mediastinum, encased in scar. The last step of the ASA difficult airway algorithm includes emergency invasive airway access, such as surgical or percutaneous airway, jet ventilation, and retrograde intubation. However this algorithm doesn’t describe the next step when invasive surgical access is unsuccessful in securing the airway. In this poster, the authors discuss the use of ECMO in an unanticipated difficult airway.