Posterior Mediastinal Mass Resection Requiring Venoarterial and Venovenous Extracorporeal Membrane Oxygenation Support

Summary Management of a mediastinal mass resection remains a challenging anesthetic scenario due to its compression on airway and major cardiovascular structures. In general, anterior mediastinal masses cause the most severe and often life-threatening complications due to the gravity effect leading to high degree of compression on the trachea, the superior vena cava, the pulmonary artery or the right heart. Posterior mediastinal mass is usually considered at lower risk because of its anatomical distance from those vital structures. Here the authors present a case of a large posterior mediastinal mass leading to severe cardiopulmonary compromise, requiring veno-arterial extracorporeal membrane oxygenation (ECMO) for surgical resection and veno-venous ECMO support for postoperative management. Though rare, posterior mediastinal masses can cause cardiopulmonary collapse with anesthesia induction, specifically with a large size tumor. Patient\u0027s positioning, physiological state and anesthetic drugs can pose dynamic changes on the severity of airway and vascular compression. It is important to recognize the potential risks of inducing anesthesia and use a multidisciplinary approach with meticulous planning for alternative management strategies that can be applied according to the patient\u0027s clinical condition.