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Giant Anterior Mediastinal Mass Requiring Awake Veno-Venous Extracorporeal Membrane Oxygenation Therapy: Case Report and Review of the Literature

Author(s): Dichtwald Sara, Meyer Avraham, Gorfil Dan M, Ifrach Nisim

Background

Anterior mediastinal masses may be the result of hematological or solid malignancies. Giant masses may cause significant compression on vital structures, including the trachea and main bronchi, and might lead to airway obstruction and respiratory collapse. Extracorporeal membrane oxygenation (ECMO) support may be life-saving in these extreme situations.

Case report

A 23-year old female admitted to the intensive care unit (ICU) in our hospital due to giant anterior mediastinal mass and severe impending airway obstruction, in which intubation could not be performed due to severe narrowing of the trachea. Awake veno-venous ECMO support was initiated in the sitting position while the patient was breathing spontaneously. ECMO support was used as a bridge to chemotherapy and decrease in tumor burden and tracheal compression.

Conclusion

In patients with large anterior mediastinal masses causing impending airway obstruction and severe narrowing of the trachea, awake ECMO may be a considerable option, with a potential to avoid difficult intubation and post-intubation airway obstruction with life-threatening respiratory collapse. ECMO support may be used as a bridge to chemotherapy, in cases of hematological malignancies, or to surgery, in cases of solid tumors.

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