Chest
Volume 109, Issue 6, June 1996, Pages 1649-1650
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Pulmonary and Critical Care Pearls
The Impossible Airway: A Plan

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A patient presented with near complete airway obstruction due to a massive tumor. Nonsurgical methods failed to secure the airway, and surgical approaches were considered unlikely to succeed in a timely fashion. Cardiopulmonary bypass via femoral-femoral cannulation with the use of local anesthesia and a portable unit, followed by IV anesthesia, allowed the surgeons to perform a controlled tracheotomy.

Section snippets

CASE REPORT

A 51-year-old woman was seen at Tripler Army Medical Center with the chief complaint of worsening difficulty in breathing associated with a huge mass of the left side of the neck. Her symptoms were of 6 months' duration but were most severe in the last month prior to examination. The patient had previously undergone total thyroidectomy on two separate occasions for goiter, reportedly secondary to Hashimoto's thyroiditis, but each time the mass returned slowly. Medical history otherwise

DISCUSSION

Surgeons faced with an upper airway obstruction initially attempt oral intubation. Should this fail, they attempt to create an airway surgically. In our case, experienced anesthesia personnel failed to secure an airway despite the utilization of fiberoptic equipment. To create an airway surgically was considered very hazardous because the location of the trachea was deep within the large tumor mass. We successfully used cardiopulmonary bypass, supporting our patient until an airway could be

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The assertions and opinions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the US Department of the Army or the US Department of Defense.

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