ECMO-/ECLS

to 80% of injuries occur within 2 cm of the carina, most commonly the proximal
right main stem bronchus.
Physical findings suggestive of an airway injury include hoarseness,
cervical crepitus, substernal tenderness, or hemoptysis. However, outwards
signs of injury may be completely absent on exam. On chest x-ray, the
common radiographic findings are subcutaneous emphysema,
pneumomediastinum, or pneumothorax. In rare cases where there is complete
transection of a distal mainstem bronchus, a “fallen lung” sign may be seen on
chest x-ray. This highly suggestive finding refers to the collapsed lung in a
dependent position, hanging only by its vascular attachments. In the absence
of clear physical or radiographic findings, clinical suspicion should be raised
when there is a large, persistent air leak after chest tube placement for
pneumothorax.
Tracheobronchial disruption is potentially fatal and requires early
diagnosis and intervention. Fiberoptic bronchoscopy can be used to confirm
and measure the extent of airway injury. In addition, interventional maneuvers
may be done at the time of bronchoscopic diagnosis, such as occlusion of the
defect with an endobronchial blocker or selective bronchial intubation of the
unaffected side.
Once tracheobronchial injury is diagnosed, surgical intervention is
indicated. Delay in surgery may result in respiratory failure in the acute setting
or eventual stenosis in the future. The disrupted tracheobronchial tree may be
repaired through a standard posterolateral thoracotomy. The right thoracic