J. L. Che Morales and G. K. Vargas Mendoza: J Extra Corpor Technol 2026, 58, 90--94 93
This outcome suggests that this personalized, multidisciplinary intervention can be replicated to help similar high-risk patients.
Conclusion
In this 50-mm acquired TEF with neurological impairment, combining femoro-femoral VV-ECMO with a Montgomery T-tube directly addressed the three key challenges-- minimizing surgical invasiveness, ensuring safe intraoperative airway control, and securing protected postoperative ventilation. VV- ECMO enabled prolonged apneic surgery with stable gas exchange, eliminating positive-pressure across the fistula and removing the ETT from the field to facilitate an extensive transcervical repair with the neck free of cannulas. The cuff-less Montgomery T-tube then provided a stable airway splint for secretion management and tailored ventilatory support during neurological recovery, avoiding the risks of prolonged intubation and protecting the repair. The uneventful intraoperative course and early radiologic closure support this evidencealigned, reproducible option for select high-risk adult TEF in experienced centers.
Acknowledgments
The authors thank the ECMO support team, Dr. Yeusvi Flores Cazola, and Jorge Avilés Rosado of the Medical Center of the Americas, for the support provided.
Funding The authors received no funding to complete this research.
Conflicts of interest The authors declare no conflict of interest.
Data availability statement All pertinent data are included in the manuscript.
Author contribution statement
GKVM: data analysis, creation of figures, and manuscript preparation. JLCM: data analysis, creation of figures, manuscript preparation, conceptualization, and editing.
Ethics approval
Ethics guidelines were respected in this case report. Written informed consent was obtained from the patient’ s family for the use of anonymized clinical data for academic purposes only.
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