Tracheal membrane laceration after tracheostomy: progressive nightmare under long term ventilation. Complex repair with vvECMO support. A case report.

Introduction: Iatrogenic tracheal membrane laceration (TML) during percutaneous dilatational tracheostomy or in rare cases during surgical tracheostomy is a problem that has gone largely unnoticed to date. We describe a case in which almost all possible complications of posterior tracheal membrane laceration long time after tracheostomy led to a life-threatening permanent condition.

Materials and methods Recurrent asphyxia occurred in a 43-year-old female under long-term ventilation for irreversible hypoxaemic respiratory insufficiency. ICU admission in our hospital was necessary because repeated events of sudden blockade of the ventilation chain occurred with hypoxic and hypercapnic coma due to mediastinal dislocation of the tube tip.

Status on admission: The patient reacted with severe panic attacks whenever the ventilator alarmed due to airway obstruction. The cuff was permanently blocked with pressures above 80 mmHg. For fear of acute blockage of the cannula during movements, the patient strictly refused any mobilization and demanded sedative medication at short intervals. A flexible bronchoscopy demonstrated a 6 cm O-shaped tracheal posterior wall lesion covered by granulation tissue.

Results: Veno-venous extracorporeal membrane oxygenation (ECMO) was able to provide oxygenation without ventilation. After transection of the trachea at the lower edge of the tracheostomy opening, the posterior wall consisted of granulation tissue, and the spinal column could be felt directly underneath with the finger. The trachea was sharply dissected, exposing the esophagus, the spine and the lateral edges of the posterior tracheal wall. The posterior membrane was then sutured and adapted continuously and a ¾ anastomosis of the trachea was then performed. This allowed the tracheostomy opening to be significantly narrowed. The cuff was airtight with low pressure. No further blockage of the cannula, was recorded the next 4 months.

Conclusion Early recognition and repair of TML during tracheostomy may prevent a vicious circle of recurrent dislocation of the tracheostomy cannula and a permanent lethal risk.

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Artikel online veröffentlicht:
18. März 2025