Airway Management for Tracheoesophageal Fistula Repair and Tracheal Repair Under Veno-Venous Extracorporeal Membrane Oxygenation.

Tracheoesophageal fistula (TEF) resection and tracheal repair are complex, multidisciplinary operations requiring careful planning and consideration for a safe and successful procedure. In particular, airway management and maintaining oxygenation are of vital importance. We report a 54-year-old female with a history of pulmonary tuberculosis complicated by tracheal stenosis, which required multiple bronchoscopic interventions. She developed a TEF, resulting in respiratory failure requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO) support for her airway interventions. She underwent tracheoesophageal resection and tracheal repair. Airway control was secured with bronchoscopic-guided endobronchial intubation and was subsequently re-positioned postoperatively, precisely within a narrow margin of safety, to maintain adequate ventilation yet avoid pressure on the tracheal repair. This case highlights the considerations and challenges regarding airway management in a patient with severe tracheal stenosis and TEF and demonstrates the utility of VV-ECMO in high-risk airway interventions.