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

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.