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Technique Awake tracheostomy for devastating airway obstruction have applied this simple, safe, efficient and low-cost procedure as a management strategy for malignant or benign tracheal obstruction that would frequently require Extracorporeal Membrane Oxygenation (ECMO) for circulatory support in other centers. Results We present a 52-year-old male with a rapidly growing neck mass, complicated by worsening orthopnea over the span of one week. A computed tomography (CT) scan revealed a huge, irregular neck mass extending from the upper mediastinum, causing severe airway compression. The patient initially had gone through an awake tracheostomy to secure tracheal obstruction, followed by a T-tube insertion under general anesthesia for both stabilization of the airway and voice preservation. Patent lumen after T-tube insertion allowed for a smooth procedure including a Magnetic Resonance Imaging (MRI) of the thorax and a Positron Emission Tomography with Computed Tomography (PET-CT) scan. An upper G-I endoscopy with a biopsy confirmed an esophageal tumor over 27–30 cm from the incisor. Following the diagnosis of squamous cell carcinoma of the esophagus with critical tracheal invasion, chemoradiotherapy was then given for definite treatment. We implemented this simple method in order to secure the devastated airway, sparing the need for a demanding rigid bronchoscopy, or use of a costly ECMO expedient. Conclusions We implemented this simple method in order to secure the devastated airway, sparing the need for a demanding rigid bronchoscopy, or use of a costly ECMO expedient.