Eltahir M, Fawzy I, Ibrahim AS, Ibrahim EA, Mazhar R, Shallik NAE, El-Menyar A, Shehatta AL. Extracorporeal membrane oxygenation support in patients with difficult airway management: Case series of 13 patients. World J Crit Care Med 2025; 14(4): 106027 [DOI: 10.5492/wjccm.v14.i4.106027]
Corresponding Author of This Article
Ayman El-Menyar, Professor, Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad Medical Corporation, Al-Rayyan Street, Doha 3050, Qatar. aymanco65@yahoo.com
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Critical Care Medicine
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 9, 2025 (publication date) through Dec 9, 2025
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World Journal of Critical Care Medicine
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2220-3141
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Eltahir M, Fawzy I, Ibrahim AS, Ibrahim EA, Mazhar R, Shallik NAE, El-Menyar A, Shehatta AL. Extracorporeal membrane oxygenation support in patients with difficult airway management: Case series of 13 patients. World J Crit Care Med 2025; 14(4): 106027 [DOI: 10.5492/wjccm.v14.i4.106027]
World J Crit Care Med. Dec 9, 2025; 14(4): 106027 Published online Dec 9, 2025. doi: 10.5492/wjccm.v14.i4.106027
Extracorporeal membrane oxygenation support in patients with difficult airway management: Case series of 13 patients
Mugahid Eltahir, Ibrahim Fawzy, Abdulsalam Saif Ibrahim, Ezzeddin A Ibrahim, Rashid Mazhar, Nabil Abd Elhamid Shallik, Ayman El-Menyar, Ahmed Labib Shehatta
Mugahid Eltahir, Ibrahim Fawzy, Abdulsalam Saif Ibrahim, Ezzeddin A Ibrahim, Ahmed Labib Shehatta, Department of Internal Medicine, Hamad Medical Corporation, Doha 3050, Qatar
Ibrahim Fawzy, Abdulsalam Saif Ibrahim, Ayman El-Menyar, Department of Clinical Medicine, Weill Cornell Medicine, Doha 24144, Qatar
Rashid Mazhar, Department of Surgery, Thoracic Surgery, Hamad Medical Corporation, Doha 3050, Qatar
Nabil Abd Elhamid Shallik, Department of Anasthesia, Hamad Medical Corporation, Doha 3050, Qatar
Nabil Abd Elhamid Shallik, Ahmed Labib Shehatta, Department of Clinical Anaethesiology, Weill Cornell Medicine, Doha 24144, Qatar
Ayman El-Menyar, Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad Medical Corporation, Doha 3050, Qatar
Author contributions: Eltahir M contributed to conceptualization, data curation, writing initial draft; Fawzy I contributed to editing and reviewing the manuscript and supervision; Ibrahim AS contributed to conceptualization and supervision; Ibrahim EA contributed to data curation and methodology; Mazhar R contributed to data sources and supervision; Shallik NAE contributed to data source and supervision; El-Menyar A contributed to supervision and reviewing the manuscript; Shehatta AL contributed to data interpretation, editing and reviewing the final manuscript, all authors read and approved this submission.
Institutional review board statement: This retrospective case series has been approved by HMC's institutional review board (IRB-04-24-385). We ensure the confidentiality of patient data by de-identifying all study records.
Informed consent statement: Not applicable in this retrospective case series study.
Conflict-of-interest statement: Authors declare no competing interests.
Data sharing statement: All data given in the manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ayman El-Menyar, Professor, Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad Medical Corporation, Al-Rayyan Street, Doha 3050, Qatar. aymanco65@yahoo.com
Received: February 14, 2025 Revised: April 9, 2025 Accepted: May 26, 2025 Published online: December 9, 2025 Processing time: 288 Days and 4.8 Hours
Abstract
BACKGROUND
In critical care practice, difficult airway management poses a substantial challenge, necessitating urgent intervention to ensure patient safety and optimize outcomes. Extracorporeal membrane oxygenation (ECMO) is a potential rescue tool in patients with severe airway compromise, although evidence of its efficacy and safety remains limited.
AIM
To review the local experience of using ECMO support in patients with difficult airway management.
METHODS
This retrospective case series study includes patients with difficult airway management who required ECMO support at a tertiary hospital in a Middle Eastern country.
RESULTS
Between 2016 and 2023, a total of 13 patients required ECMO support due to challenging airway patency in the operating room. Indications for ECMO encompassed various diagnoses, including tracheal stenosis, external tracheal compression, and subglottic stenosis. Surgical interventions such as tracheal resection and anastomosis often necessitated ECMO support to maintain adequate oxygenation and hemodynamic stability. The duration of ECMO support ranged from standby mode (ECMO implantation is readily available) to several days, with relatively infrequent complications observed. Despite the challenges encountered, most patients survived hospital discharge, highlighting the effectiveness of ECMO in managing difficult airways.
CONCLUSION
This study underscores the crucial role of ECMO as a life-saving intervention in selected cases of difficult airway management. Further research is warranted to refine the understanding of optimal management strategies and improve outcomes in this challenging patient population.
Core Tip: Veno-venous Extracorporeal membrane oxygenation (VV ECMO) is occasionally used in airway obstruction, but the literature remains limited. Difficult airway management can be fatal without advanced support strategies. Complex and deformed airways can challenge even the most experienced anesthesiologist. Current approaches and techniques for such patients may be inadequate. VV ECMO can be a bridge to definitive airway establishment and surgical intervention. VV ECMO can be safely and effectively instigated during the perioperative period and can avoid mishaps in difficult and failed intubation scenarios. Multidisciplinary team engagement and meticulous planning are key to the successful management of cases with difficult airways.
