E Before A: Awake Bi-femoral Veno-Venous Extracorporeal Membrane Oxygenation as a Bridge to the Bifurcation Tracheal Y Stent.

A 64-year-old female presented with severe respiratory failure secondary to a high-grade non-small lung cancer (IIIA NSCLC) causing extrinsic and intrinsic compression of the right main bronchus. She remained hypoxic despite 100% FiO2 delivery by high-flow nasal cannula and was considered at high risk of airway loss at intubation. Tumor debulking, histological diagnosis, and restoration of airway patency were facilitated with peri-procedural veno-venous extracorporeal membrane oxygen support (VVECMO). We describe a case of awake bifemoral VVECMO cannulation performed uneventfully as a bridge to the palliative placement of a self-expanding tracheal Y stent. The circuit was maintained in the absence of systemic anticoagulation. After less than 24 hours of extracorporeal support, the patient was decannulated, liberated from supplementary oxygen, and discharged from intensive care. The patient is now receiving platinum-based chemoradiotherapy and is eligible for targeted consolidative immunotherapy. As therapies and practice evolve, extracorporeal support may serve as a bridge to palliative interventions intended to salvage and improve the quality of life in oncology patients. Awake cannulation is feasible and may be preferred in cases of malignant airway obstruction.