Case Report: Successful repair of traumatic right main bronchial transection under veno-venous ECMO support with postoperative inhaled nitric oxide.

Background: Traumatic bronchial transection is a rare but life-threatening consequence of blunt chest trauma. When severe hypoxemia persists despite intubation and mechanical ventilation, maintaining adequate gas exchange during airway reconstruction becomes a major challenge. Case presentation: We describe a 52-years-old male who sustained a complete right main bronchus transection after a crush-related traffic accident. Despite intubation and maximal ventilatory support, oxygenation remained critically low. Emergency venovenous extracorporeal membrane oxygenation (VV-ECMO) was initiated by the intensive care unit (ICU) team, enabling safe surgical exposure and successful end-to-end bronchial anastomosis. Inhaled nitric oxide (iNO) was administered postoperatively to improve ventilation-perfusion matching. ECMO was discontinued on postoperative day (POD 2) while the patient remained on mechanical ventilation. Inhaled nitric oxide was successfully weaned on POD 4, followed by tracheostomy on the same day. The patient was liberated from mechanical ventilation on POD 13. He recovered fully and was discharged home. Conclusion: This case highlights the potential role of VV-ECMO as a bridge to repair in traumatic bronchial transection with refractory hypoxemia and suggests that adjunctive iNO may assist perioperative oxygenation management.