@drzackmd: When managing an extreme neck mass, you need more than an awake fiberoptic plan. If severe extrinsic compression prevents passing an endotracheal tube and the tumor distorts landmarks so badly that emergency surgical front of neck access is impossible, you are facing a complete cannot intubate, cannot oxygenate nightmare. In specialized tertiary centers, venovenous (VV) ECMO standby or pre-induction cannulation under local anesthesia provides a critical safety net. VV-ECMO pulls deoxygenated venous blood, oxygenates it via an external membrane, and returns it to the venous system, temporarily bypassing pulmonary ventilation entirely. If your facility doesn't have ECMO capabilities or advanced thoracic support, transfer the patient to a center that does before pushing induction drugs. #DrZackMD #Anesthesiology #AirwayManagement #ECMO #CriticalCare

Dr Zack, MD

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Tuesday 29 September 2026 13:00:00 GMT