Use of Laryngeal Mask Airway as a Bridge to Extracorporeal Membrane Oxygenation in a Neonate with Undiagnosed Tracheal Stenosis

¹Department of Pediatrics, Division of Neonatology at Texas Children’s Hospital; Baylor College of Medicine; Houston, TX
²Department of Pediatrics, Division of Pediatric Radiology at Texas Children’s Hospital; Baylor College of Medicine; Houston, TX 

*Corresponding author: Lauren E. Swanson, Department of Pediatrics, Division of Neonatology at Texas Children’s Hospital; Baylor College of Medicine; Houston, TX 77030, USA, Tel: (412)-952-6445; Fax: (832)-825-1386; E-mail: [email protected].
Received: July 07, 2020
Publication: October 22, 2020

Citation: Swanson LE. (2020). Use of Laryngeal Mask Airway as a Bridge to Extracorporeal Membrane Oxygenation in a Neonate with Undiagnosed Tracheal Stenosis. Neonatal. 1(1):01.

Citation: Swanson LE. (2020).

ABSTRACT

We describe a 37-week gestation infant admitted to the neonatal intensive care unit with prenatal diagnosis of Trisomy 21 and atrioventricular canal. Initial course was uneventful. He required high-flow nasal cannula and diuretics secondary to pulmonary over-circulation. Due to inadequate oral feeding despite optimizing therapies, the infant underwent gastrostomy tube surgery. He was intubated in the operating room by anesthesia. Following extubation, he developed respiratory distress unresponsive to racemic epinephrine and dexamethasone. He was unable to be reintubated beyond the level of the vocal folds despite attempts by neonatology, anesthesia, and otolaryngology. A laryngeal mask airway was inserted. The patient was transported for computed tomography of the airway to establish the anatomy and site of obstruction. Imaging revealed long-segment tracheal stenosis with complete cartilaginous rings. In the setting of both airway obstruction requiring tracheoplasty as well as atrioventricular canal defect requiring repair, the multidisciplinary team decided to cannulate the infant for veno-arterial extracorporeal membrane oxygenation. This is the first known neonatal case involving use of laryngeal mask airway as a bridge first to diagnostic imaging then to extracorporeal membrane oxygenation in a patient with critical airway malformation and congenital heart disease within the first year of life. We encourage readers to think of congenital tracheal stenosis as a rare differential diagnosis in the evaluation of an infant with post-extubation respiratory distress of unclear etiology. We also highlight the viability of laryngeal mask airway as a bridge to diagnostic imaging before cannulation for extracorporeal life support.

KEYWORDS: Airway Malformation; Laryngeal Mask Airway; Congenital Tracheal Stenosis; Extracorporeal Membrane Oxygenation