Operative Management of Tracheobronchial Injuries with and Without Extracorporeal Membrane Oxygenation Support

Objective Traumatic airway injury is rare but often fatal. This study aims to characterize the operative management and postoperative outcomes of major airway injuries seen at a tertiary care center, evaluate the role of extracorporeal membrane oxygenation (ECMO) in management, and contextualize these findings using national registry data. Methods We conducted a retrospective review of patients with tracheobronchial injuries at a single center between 2015–2025. Data collected included demographics, injury mechanism, operative details, ECMO utilization, and outcomes. The ELSO database was then queried to identify ECMO utilization for such injuries and outcomes at a national level. Results Between 2015 and 2025, 13 patients underwent operative repair of traumatic tracheobronchial injuries (Table 1). Mechanisms included blunt trauma (n=3), penetrating trauma (n=3), and iatrogenic injury (n=7). Four patients required venovenous (VV) ECMO support for refractory hypoxemia (n=3) and hypercarbia (n=1), with mean duration of 6 days. One patient required intraoperative veno-venoarterial ECMO for hypoxemia with hemodynamic instability and was decannulated at the conclusion of the case. Median intubation duration was 1 day (IQR 0-7, range 1-63 days). Mean hospital length of stay was 20.6±17.7 days. In a national cohort of all patients placed on VV ECMO for tracheobronchial injuries, 45 injuries occurred, with an average ECMO duration of 10.0 ± 16.5 days and a majority surviving to discharge (34/45, 75.6%). Conclusions Operative repair of tracheobronchial injuries is feasible despite complexity; VV ECMO can be a useful adjunct. Further multicenter studies are needed for further characterization.