Emergency Medicine Department, Emergency Medical Laboratory, West China Hospital, Sichuan University, Chengdu, 610041, China.
Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.
Sci Rep. 2023 Mar 6;13(1):3749. doi: 10.1038/s41598-023-30665-1.
Central airway obstruction caused by neck and chest tumors is a very dangerous oncological emergency with high mortality. Unfortunately, there is few literature to discuss an effective way for this life-threating condition. Providing effective airway managements, adequate ventilation and emergency surgical interventions are very important. However, traditional airway managements and respiratory support has only limited effect. In our center, using extracorporeal membrane oxygenation (ECMO) as a novel approach to manage patient with central airway obstruction caused by neck and chest tumors has been adopted. We aimed to show the feasibility: using early ECMO to manage difficult airway, provide oxygenation and support surgical procedure for patients with critical airway stenosis caused by neck and chest tumors. We designed a single-center, small sample size retrospective study based on real-world. We identified 3 patients with central airway obstruction caused by neck and chest tumors. ECMO was used to ensure adequate ventilation to emergency surgery. Control group cannot be established. Because traditional manner very likely led to death of such patients. Details of clinical characteristics, ECMO, surgery and survival outcomes were recorded. Acute dyspnea and cyanosis were the most frequent symptoms. All patients (3/3) showed descending arterial partial pressure of oxygen (PaO). Computed tomography (CT) revealed severe central airway obstruction caused by neck and chest tumors in all cases (3/3). All patients (3/3) had definite difficult airway. All cases (3/3) received ECMO support and emergency surgical procedure. Venovenous ECMO was the common mode for all cases. 3 patients weaned off ECMO successfully without any ECMO-related complications. Mean duration of ECMO was 3 h (range: 1.5-4.5 h). Under ECMO support, difficult airway management and emergency surgical procedure were finished successfully for all cases (3/3). The mean ICU stay was 3.3 days (range: 1-7 days), and the mean general ward stay was 3.3 days (range: 2-4 days). Pathology demonstrated the tumor dignity for 3 patients including 2 malignant cases and 1 benign case. All patients (3/3) were discharged from hospital successfully. We showed that early ECMO initiation was a safe and feasible approach to manage difficult airway for patients with severe central airway obstruction caused by neck and chest tumors. Meanwhile, early ECMO initiation could ensure security for airway surgical procedure.
颈部和胸部肿瘤导致的中央气道阻塞是一种非常危险的肿瘤急症，死亡率很高。不幸的是，针对这种危及生命的情况，目前几乎没有文献讨论有效的治疗方法。提供有效的气道管理、充分的通气和紧急手术干预非常重要。然而，传统的气道管理和呼吸支持方法效果有限。在我们中心，使用体外膜氧合（ECMO）作为一种新的方法来管理颈部和胸部肿瘤导致的中央气道阻塞患者已经被采用。我们旨在展示其可行性：使用早期 ECMO 来管理困难气道，为因颈部和胸部肿瘤导致严重气道狭窄的患者提供氧合和支持手术过程。我们基于真实世界情况设计了一项单中心、小样本量的回顾性研究。我们确定了 3 例因颈部和胸部肿瘤导致中央气道阻塞的患者。使用 ECMO 确保充分通气，然后紧急进行手术。因为对于这些患者，传统方式很可能导致死亡，所以无法建立对照组。患者的临床特征、ECMO、手术和生存结果的详细信息均被记录。急性呼吸困难和发绀是最常见的症状。所有患者（3/3）的动脉血氧分压（PaO）均下降。所有病例（3/3）的计算机断层扫描（CT）均显示颈部和胸部肿瘤导致严重中央气道阻塞。所有患者（3/3）均存在明确的困难气道。所有患者（3/3）均接受 ECMO 支持和紧急手术。静脉-静脉 ECMO 是所有患者的常见模式。3 例患者均成功脱机，无任何 ECMO 相关并发症。ECMO 时间平均为 3 小时（范围：1.5-4.5 小时）。在 ECMO 支持下，所有患者（3/3）均成功完成困难气道管理和紧急手术。所有患者（3/3）的 ICU 住院时间平均为 3.3 天（范围：1-7 天），普通病房住院时间平均为 3.3 天（范围：2-4 天）。病理检查显示 3 例患者的肿瘤分级包括 2 例恶性病例和 1 例良性病例。所有患者（3/3）均成功出院。我们表明，早期 ECMO 启动是一种安全可行的方法，可用于管理因颈部和胸部肿瘤导致的严重中央气道阻塞患者的困难气道。同时，早期 ECMO 启动可以为气道手术提供安全性保障。
