Background: Perioperative airway management and oxygenation maintenance during central airway obstruction (CAO) treatment pose great challenges. While veno-venous extracorporeal membrane oxygenation (V-V ECMO) shows promise as a bridge therapy, optimal implementation and management strategies remain lacking. We present our experience with V-V ECMO in CAO management from a high-volume center. Methods: We retrospectively analyzed 29 consecutive patients who received V-V ECMO support for CAO between 2015 and 2023. Patient demographics, clinical characteristics, ECMO cannulation and operation parameters, interventional procedures, complications, and outcomes were reviewed. Results: Among patients with median airway diameter of 4.5 mm (IQR 2–5 mm), etiologies included primary tumors (n = 17), metastases (n = 7), and post-intubation/tracheostomy stenosis (n = 5). Treatment comprised bronchoscopic interventions (n = 9) and surgical procedures (thoracic = 15, head/neck = 5). Using predominantly femoral-jugular cannulation (n = 27), we implemented a minimal anticoagulation protocol (catheter flush with 5U/mL heparin only). All patients survived through 6-month follow-up with minimal ECMO-related complications. Conclusion: The application of V-V ECMO with minimal anticoagulation demonstrates safety and efficacy as a bridging support in the therapeutic approach to CAO.

Veno-arterial (V-A) and veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) are crucial support modalities during lung transplantation, yet their comparative effectiveness remains unclear. We conducted an 8-year retrospective analysis of 62 lung transplant recipients who received intraoperative ECMO (29 V-A, 33 V-V). Baseline characteristics, surgical parameters, and clinical outcomes were compared. To address potential selection bias, we employed entropy weighted inverse probability of treatment weighting (IPTW-EW). After IPTW-EW adjustment, V-A ECMO was associated with superior hemodynamic and respiratory parameters, including lower systolic pulmonary artery pressure (30 vs. 37 mmHg, p = 0.007), higher arterial oxygen partial pressure (119 vs. 78 mmHg, p = 0.002), and less severe pulmonary edema (Grade 1: 50% vs. 3%, Grade 2: 45% vs. 38%, Grade 3: 5% vs. 59%, p < 0.001). Notably, V-A ECMO demonstrated significantly lower 28-day (5% vs. 29%, p = 0.017) and hospital mortalities (21% vs. 69%, p = 0.035). V-A ECMO provides superior pulmonary circulation unloading and is associated with improved survival outcomes compared to V-V ECMO in lung transplantation, suggesting its preferential use when clinically appropriate.

While glycemic variability (GV) affects outcomes in critically ill patients, its temporal patterns and prognostic implications in severe pneumonia remain unclear. This study aimed to identify distinct GV trajectory patterns and their associations with clinical outcomes. This prospective cohort study enrolled 315 patients with severe pneumonia admitted to our intensive care unit (ICU) at Taicang Hospital of Nanjing University of Chinese Medicine, from January 2021 to December 2024. Using group-based trajectory modeling (GBTM), we analyzed the coefficient of variation (CV) trajectories during the first 5 ICU days. We compared clinical characteristics between trajectory groups, conducted exploratory landmark survival analysis, and assessed the performance of clinical parameters for identifying trajectory classification. GBTM identified two distinct GV trajectories: Dynamic Variant (DV, 12.1%) characterized by initially high variability that gradually decreased but remained persistently elevated, and Stable Control (SC, 87.9%) with consistently low variability. While early outcomes were comparable, after day 14, the DV group demonstrated significantly higher mortality (70.3% vs. 60.0%, p = 0.034). DV patients had higher procalcitonin (PCT, 2.35 vs. 0.76 ng/ml, p = 0.030) and glycated hemoglobin A1c (HbA1c, 7.1% vs. 6.3%, p = 0.002) levels on ICU admission, despite similar disease severity scores and other clinical parameters. Combined prediction using PCT and HbA1c showed good performance in identifying trajectories (Area Under the Receiver Operating Characteristic curve: 0.87, 95% Confidence Interval: 0.80-0.94). Distinct GV trajectories in severe pneumonia patients are associated with differential subsequent mortality risks, with admission PCT and HbA1c levels serving as predictors of trajectory group classification. Not applicable.