What happened, in summary

A 66-year-old former smoker presented with severe shortness of breath after several unsuccessful courses of antibiotics and steroids for presumed pneumonia and chronic obstructive lung disease. He was admitted to intensive care with respiratory failure. CT imaging revealed a large tumor at the carina that completely blocked the right mainstem bronchus and partly blocked the left. His condition worsened over three days despite two emergency sessions of external-beam radiation.

Because the mass nearly closed both main airways, clinicians initiated urgent venovenous extracorporeal membrane oxygenation through the femoral veins. Bronchoscopy showed a large distal-tracheal tumor with pooled purulent secretions beyond the obstruction. While ECMO maintained oxygenation, rigid bronchoscopy was used to debulk the mass and reopen the airways. The support was stopped after five hours, and he was extubated in the operating room.

Pathology identified invasive, moderately differentiated squamous cell carcinoma. The procedure was performed as a rescue from respiratory distress rather than as a curative resection, so tumor margins were not collected. He was discharged eight days after the operation and then received cisplatin-based chemoradiation. At three months, repeat bronchoscopy, brushing, and biopsy showed inflammation and atypical detached cells but no malignancy. He had no immediate or long-term complications from ECMO and remained disease-free one year after discharge.