When cardiopulmonary bypass is not an option-a case of massive retrosternal goiter with severe tracheal compression in an extremely obese patient

Recent literature has highlighted the successful use of extracorporeal membrane oxygenation (ECMO) in severe airway obstruction due to mediastinal mass when all other conventional management options have failed.1, 2 However, this case report of a massive retrosternal goiter (RSG) highlights that mechanical circulatory support (ie, ECMO or cardiopulmonary bypass [CPB]) may not be possible in all cases of severe airway obstruction. The authors describe an approach to mediastinal masses that mitigates the risk of airway loss and cardiovascular collapse—a crucial objective for cases in which CPB is not a viable rescue option. Written patient consent for publication of this case was obtained

Spontaneous respiration using intravenous anesthesia and high-flow nasal oxygen (STRIVE Hi) management of acute adult epiglottitis: a case report

High-flow nasal oxygen (HFNO) is a potentially life-saving adjunct in the emergency management of the obstructed airway. HFNO has multiple beneficial applications in critical care and respiratory support, but its use in emergency-obstructed airway management has not been defined. This case report describes spontaneous respiration using intravenous anesthesia and high-flow nasal oxygen to successfully manage acute adult epiglottitis with rapidly progressing airway obstruction. Oxygenation, carbon dioxide levels, and airway patency were maintained, which facilitated endotracheal intubation while the patient was spontaneously breathing during general anesthesia. The application of HFNO can be extended to emergency airway obstruction