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Malignant central airway obstruction and combined anatomical-physiological difficult airway – A case report
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Date
2026-02-18
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Abstract
We report the case of a 68-year-old woman who presented with acute respiratory distress following a prolonged history of cough, dyspnoea, dysphagia, and unintentional weight loss. Computed tomography revealed a fungating oesophageal mass invading the trachea, resulting in near-critical supra-carinal airway narrowing consistent with advanced oesophageal carcinoma. Despite optimized medical therapy, her respiratory status remained unstable. Following multidisciplinary discussion, a planned airway strategy was undertaken, including elective endotracheal intubation supported by pre-emptive venovenous extracorporeal membrane oxygenation (VV-ECMO), rigid bronchoscopy, tumour debulking, and bilateral tracheobronchial stenting. The postoperative course was favourable, with ECMO decannulation on day 3 and successful extubation on day 4.This case exemplifies a combined anatomical–physiological difficult airway, in which severe airway distortion coexists with limited cardiopulmonary reserve, rendering conventional airway management difficult. In such scenarios, VV-ECMO can provide a controlled platform for oxygenation and ventilation during definitive airway intervention, reducing the risk of life-threatening hypoxaemia. Although current airway management guidelines offer limited guidance on ECMO use, this case highlights its value as a selective adjunct in high-risk malignant central airway obstruction, particularly in patients with a combined anatomical–physiological difficult airway.