Elective use of extracorporeal membrane oxygenation during pediatric tracheal surgery: A series of four cases

The use of extracorporeal membrane oxygenation (ECMO) in pediatric tracheal surgery is rare but can provide hemodynamic and respiratory stability in complex procedures. We present a series of four pediatric cases in which intraoperative ECMO was used for tracheoesophageal fistula repair and tracheal tumor resection. In all cases, veno-venous ECMO (VV-ECMO) or veno-arterial ECMO (VA-ECMO) was employed for a short duration, allowing airway management and surgical manipulation under stable oxygenation and hemodynamic conditions. No major ECMO-related intraoperative adverse events were observed; however, one patient required reoperation with cardiopulmonary bypass because of postoperative recurrence. These findings suggest that ECMO, particularly VV-ECMO, may be a valuable strategy in pediatric tracheal surgery, though further studies are needed to assess its long-term benefits.