An alternate approach to the management of tracheal perforation in a child

Tracheal perforation can be difficult to manage when standard approaches are not feasible. We present a case report of a 2-year-old child who sustained a traumatic laceration of the intrathoracic trachea in the face of tracheitis and bronchitis. Accepted management techniques could not be employed because the child developed mediastinitis and respiratory distress syndrome. The use of extracorporeal membrane oxygenation (ECMO) facilitated ventilation and oxygenation when standard modes of ventilation failed. ECMO also provided a compliant low-pressure environment that allowed primary tracheal repair by wrapping the tracheal tear with a pedicle of intercostal muscle. A brief overview of the management of intrathoracic tracheal disruption is presented. © 1994 Springer-Verlag