# Posterior Tracheal Wall Laceration Following Tracheostomy: A Progressive Nightmare Under Long-Term Ventilation, Requiring Complex Repair With vvECMO Support—A Case Report

## TL;DR

A patient with a tracheal membrane laceration after tracheostomy faced life-threatening complications requiring complex surgical repair with ECMO support.

## Contribution

This case report highlights the rare but severe complications of untreated tracheal membrane laceration and its management using advanced surgical and ECMO techniques.

## Key findings

- Untreated tracheal membrane laceration can lead to life-threatening airway blockage and hypercapnic coma.
- Repair under veno-venous ECMO required tracheal transection and reconstruction with a new tracheostomy channel.
- Late repair of chronic TML is complex and poses significant risks even in experienced centers.

## Abstract

Untreated tracheal membrane laceration (TML) may have life-threatening consequences. We present a case of untreated TML during or after tracheostomy. Air leakage along the cannula after tracheostomy was treated with raising cuff pressure up to > 100 mmHg and enlarging the tracheal lumen in the area of TML. Finally, small movements of the neck led to immediate blockade of the tubetip and repeated life-threatening asphyxia. Immobilization, anxiety states, addiction to sedatives, and several situations with hypercapnic coma led to ICU transferal to our tertiary thoracic center. Chronic TML was diagnosed with flexible bronchoscopy through the larynx and the tracheostomy. Operative repair under veno-venous extracorporeal membrane oxygenation (vvECMO) required tracheal transection at the lower border of the tracheostomy and detachment of both edges of the ruptured tracheal membrane from the anterior vertebral ligament and reconstruction with a running suture. With a 3/4 reanastomosis of the trachea, a new tracheostomy channel was created. Within the following 4 months, no further ventilation problems occurred. We conclude that untreated TML after tracheostomy may develop in a vicious circle with a permanent risk of death under long-term ventilation. Late repair can be complex even in experienced hands.