ECMO-Supported Airway Tumor Removal in Stage IIB Lung Cancer

What happened, in summary

A 52-year-old man with hemophilia A and hepatitis C developed coughing of blood and severe respiratory failure that required intubation. CT imaging showed a right suprahilar mass completely blocking the right mainstem bronchus and possibly extending into the mediastinum. Bronchoscopy removed an obstructing clot, but conventional techniques could not remove the solid tumor beneath it.

Eleven days after admission, venovenous extracorporeal membrane oxygenation was established through the right internal jugular vein to maintain gas exchange during a high-risk airway procedure. With ECMO support, clinicians debulked the tumor in the right mainstem bronchus and bronchus intermedius and reopened ventilation to the right lung. ECMO was discontinued after four hours. Despite his bleeding disorder and the anticoagulation needed for ECMO, estimated blood loss was 150 mL.

Pathology showed poorly differentiated non-small cell lung carcinoma, stage IIB with T2aN1 classification. The airway procedure was a rescue intervention rather than a curative resection, so surgical margins were not collected. He was extubated on postoperative day seven and discharged the following day after a total hospital stay of 19 days. Subsequent treatment combined carboplatin and paclitaxel with radiation, followed by durvalumab. He had no immediate or long-term neurologic complications from ECMO and remained on systemic treatment at the last documented follow-up.