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DOI:
https://doi.org/10.57187/5263

Clinical reasoning: Case report

Vol. 156 No. 7 (2026)

Near-fatal foreign body aspiration – bronchoscopic rescue by the “push-down manoeuvre” and retrieval under ECMO: a case report

Cite this as:
Swiss Med Wkly. 2026;156:5263
Published
23.07.2026

Summary

In this case report, we describe a child with a near-fatal foreign body aspiration rescued by a unique lifesaving endoscopic manoeuvre and transfer for foreign body retrieval to an extracorporeal membrane oxygenation (ECMO) centre.

A 2-year-5-month-old girl suffered a near-fatal foreign body aspiration at home and was successfully resuscitated by the paramedics. On arrival, she was severely dyspnoeic, hypercapnic and cyanotic, showed marked paradoxical breathing movements with hardly any breath sounds consistent with near-complete central airway obstruction. After induction of anaesthesia for emergency bronchoscopy, bag mask ventilation was nearly impossible resulting in a “cannot ventilate, cannot oxygenate” scenario and bradycardia. Only after successfully pushing down the foreign body into the right main bronchus (push-down manoeuvre) was mask ventilation successful. Any further manipulation led to severe desaturations and attempts to retrieve the foreign body were impossible. Therefore, transfer to the nearest centre with paediatric ECMO facilities via air ambulance was carried out. Foreign body retrieval was successful under veno-venous ECMO and the girl showed a complete recovery without any neurological sequelae.

In this case of total airway obstruction, the bronchoscopic push-down manoeuvre was lifesaving and allowed temporary stabilisation to enable transport to a centre where secondary difficult foreign body retrieval was performed under ECMO.

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