Airway complications of pediatric extracorporeal membrane oxygenation

Objectives: Prolonged intubation is a risk factor for the development of laryngotracheal stenosis. Children who undergo extracorporeal membrane oxygenation (ECMO) usually remain intubated for an extended period. It is unclear whether the impaired cardiorespiratory status that necessitated ECMO places these children at a higher risk of laryngotracheal stenosis. This study was performed to assess the incidences of laryngotracheal stenosis and tracheostomy in children who undergo ECMO. Methods: We identified all patients under 18 years of age who underwent ECMO over a 10-year period concluding July 1, 2009, by use of the extracorporeal life support database of Royal Children's Hospital, Melbourne. All children in this database who underwent either a diagnostic or a therapeutic surgical procedure on the airway were identified. Results: The 218 patients included in the study had an overall survival rate of 51.4%. A total of 14 patients (6.4%) required a surgical procedure on the airway, and 11 of these (5.0%) needed tracheostomy. Ten of these 14 patients (71.4%) survived; of these, 2 presented with congenital laryngotracheal stenosis, 3 developed clinically significant laryngotracheal stenosis as a likely consequence of ECMO, and 5 required tracheostomy alone for long-term ventilation. The rate of airway stenosis was 2.7% in survivors. Conclusions: The rate of laryngotracheal stenosis in children who require ECMO is acceptably low.5 page(s