Extracorporeal membrane oxygenation for perioperative support during congenital tracheal stenosis repair.

xtracorporeal membrane oxygenation (ECMO) is routinely used for cardiopulmonary support E in a wide variety of neonatal diseases, such as meconium aspiration syndrome, respiratory distress syndrome, persistent pulmonary hypertension, sepsis syndrome, and severe pneumonia. Extracorporeal membrane oxygenation is also potentially useful as a component of preoperative care for infants with profound respiratory failure and surgical lesions such as congenital diaphragmatic hernia (1). We recently used ECMO intraoperatively to support a baby with congenital tracheal stenosis (CTS) and continued using ECMO during the postoperative period to avoid trauma to the tracheal anastomosis. Extracorporeal membrane oxygenation was continued for 7 days, after which the patient was safely returned to mechanical ventilation. This hybrid approach is similar to that used in patients with unrepaired congenital diaphragmatic hernia (2). Neonatal CTS, which presents with severe symptoms in the first days of life, has a high mortality (44%-79%), and sudden death is common (3,4). If the lesion is near or includes the carina or involves >50% of the trachea, repair is both difficult and dangerous. A variety of surgical approaches have been used. The surgical repair of choice is primary tracheal resection and anastomosis (5). Most surgeons believe that up to 50% of the length of the infant trachea can be primarily resected (1). Where the lesion involves >50% of the trachea, tracheal reconstruction has been performed using a variety of materials to fill the defect, including costochondral grafts (3,6), pericardium (9, and esophagus (4). Regardless of the method of repair, providing ventilation and oxygenation during surgical correction of the trachea is one of the anesthesiologist’s greatest challenges. If an endotracheal tube can be