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      Complete Tracheal Transection in a 3-Year-Old After Blunt Neck Trauma: a Case Report

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          Abstract

          Pediatric laryngotracheal injuries from blunt force trauma are rare but can lead to significant morbidity and mortality. In pediatric patients with severe laryngotracheal disruption, extracorporeal membrane oxygenation has been used to improve oxygenation and ventilation until definitive repair can be performed. We describe the case of a 3-year-old girl with blunt neck trauma secondary to an all-terrain vehicle accident in which her neck was clotheslined against a fence, leading to a complete tracheal transection at the C7-T1 level. Emergent extracorporeal membrane oxygenation cannulation was initiated. We discuss the evaluation and management of tracheal injuries and the requisite multidisciplinary team approach. Pediatric patients with laryngotracheal trauma require definitive airway management, which should be performed by skilled personnel.

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          Most cited references17

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          The use of extracorporeal membrane oxygenation therapy in the delayed surgical repair of a tracheal injury.

          Acute tracheal injury secondary to intubation can present with varying degrees of severity. Onset of symptoms occur hours or even days after the initial injury. A 34-year-old woman required surgery for a large tracheal tear after emergency intubation. The inability to adequately ventilate combined with secondary aspiration injury required that the patient be placed on extracorporeal membrane oxygenation before undergoing surgery. This case demonstrates the use of extracorporeal membrane oxygenation to manage a patient awaiting surgery for severe tracheal tears.
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            Management of blunt tracheobronchial trauma in the pediatric age group.

            Tracheobronchial rupture (TBR) due to blunt chest trauma is a rare but life-threatening injury in the pediatric age group. The aim of this study was to propose a treatment strategy including bronchoscopy, surgery and extracorporeal membrane oxygenation (ECMO) to optimize the emergency management of these patients.
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              ECMO support for right main bronchial disruption in multiple trauma patient with brain injury--a case report and literature review.

              Extracorporeal membrane oxygenation (ECMO) may offer life-saving treatment in severe pulmonary contusion or acute respiratory distress syndrome when conventional treatments have failed. However, because of the bleeding risk of systemic anticoagulation, ECMO should be performed only as a last resort in multiple trauma victims. Here, we report ECMO as a bridge for right main bronchus reconstruction and recovery of traumatic wet lung in a 31-year-old male multi-trauma patient with right main bronchial disruption, bilateral pulmonary contusion, cerebral contusion and long bone fracture. The patient was discharged without any obvious complication. ECMO support in a traumatic brain injured patient with severe hypoxemia caused by lung contusion and/or tracheal bronchus disruption is not an absolute contraindication.
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                Author and article information

                Journal
                Rom J Anaesth Intensive Care
                Rom J Anaesth Intensive Care
                rjaic
                rjaic
                Romanian Journal of Anaesthesia and Intensive Care
                Sciendo
                2392-7518
                2502-0307
                July 2020
                10 August 2020
                : 27
                : 1
                : 4-10
                Affiliations
                [1 ]deptDepartment of Anesthesiology , universityUniversity of Florida College of Medicine , Gainesville, Florida, USA
                [2 ]Present address: deptDepartment of Anesthesiology and Pain Management , UT Southwestern, Children's Medical Center Dallas , 1935 Medical District Drive, Dallas, TX 75235.
                [3 ]Present address: deptDepartment of Anesthesiology & Critical Care – Clinic, Nemours Children's Specialty Care private , Jacksonville, 807 Children's Way, Jacksonville, FL 32207.
                [4 ]deptDivision of Pediatric Otolaryngology , universityUniversity of Florida College of Medicine , Gainesville, Florida, USA
                Author notes
                Article
                rjaic-2020-0003
                10.2478/rjaic-2020-0003
                8158306
                34056117
                22dd8b22-775f-4c60-8144-b232183846f8
                © 2020 Cameron R. Smith et al., published by Sciendo

                This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

                History
                Page count
                Pages: 7
                Categories
                Case Report

                extubation,extracorporeal membrane oxygenation,laryngeal trauma,pediatric,trachea

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