Y-stent for tracheal tear under extracorporeal membrane oxygenation (ECMO): A success story

Abstract

Introduction: Tracheal tear is a rare, life-threatening complication of endotracheal tube insertion. We report a case of a patient who had a tracheal tear following a routine video-assisted thoracoscopicsuergery (VATS) sympathectomy. A silicon Y-stent was inserted while she was put on extracorporeal membrane oxygenation (ECMO) as a bridge to the destined therapy.

Case Report: A 24-year old lady presented with bilateral palmar hyperhidrosis since childhood. Apart from sweaty palms and feet, her physical examination was otherwise unremarkable. She subsequently underwent VATS sympathectomy where she was intubated with double lumen,32fr endotracheal tube (ETT). Bronchoscopy confirmed the correct ETT placement, and her surgery was performed without delay. However, she desaturated intraoperatively, thus the surgery was stopped. On table bronchoscopy done by the pulmonology team confirmed a deep laceration measuring 1cm above carina, and 2cm in length. Rigid bronchoscopy with Y-stent insertion was done on day 5 of event, in view of persistent laceration. The Y-stent was deployed successfully with intended limb 2cm in the right main bronchus (RMB) and 1cm in the left main bronchus (LMB). The patient was able to be weaned off ECMO 1-day after Y-stent insertion, and she was subsequently well to be discharged. She successfully had her Y-stent removed 2-months post procedure and a surveillance bronchoscopy 1-month post Y-stent removal showed well healed tracheal tear site with presence of granulation tissue.

Conclusion: Y-stent insertion in a patient with small tracheal injury is a viable and feasible option. Its deployment had improved the healing process of the injury site.