Abstract
Penetrating tracheal injuries present unique challenges for airway management, ventilation, and surgical repair due to the risk of rapid airway decline. We present a case of a 34-year-old male who sustained an arrow injury to the neck. Given the risk of airway compromise with induction or movement, venovenous extracorporeal membrane oxygenation (VV ECMO) was initiated prior to anesthesia. Awake bronchoscopy confirmed tracheal injury with an embedded arrow. The patient underwent successful tracheal repair and robotic arrow extraction under ECMO support. He was weaned off ECMO intraoperatively and discharged without complications. This case highlights the utility of early VV ECMO as a bridge to definitive airway and surgical management in complex penetrating airway trauma.