Tracheostomy Is Safe During Extracorporeal Membrane Oxygenation Support
- 16 August 2019
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in ASAIO Journal
- Vol. 66 (6), 652-656
- https://doi.org/10.1097/mat.0000000000001059
Abstract
Patients receiving extracorporeal membrane oxygenation (ECMO) often require prolonged mechanical ventilation. Providers may be reluctant to perform tracheostomies on patients during ECMO due to their tenuous clinical status and systemic anticoagulation. We report our experience with performing open and percutaneous tracheostomies on patients supported on ECMO from August 2009 to December 2017. Of the 127 patients who underwent tracheostomy during ECMO support, the median age was 42 years (interquartile range [IQR], 29-54), 99 (78%) patients had venovenous (VV) cannulation, 22 (17%) patients had venoarterial (VA) cannulation, and six (5%) patients had hybrid configurations. Percutaneous tracheostomy was performed in 110 (87%) patients. Median-activated partial thromboplastin time (aPTT) at the time of tracheostomy was 47.5 seconds (IQR, 41-57.6 seconds). The median time from ECMO initiation to tracheostomy was 7 days (IQR, 4-11 days). A total of 55 patients (43%) received packed red blood cell (pRBC) transfusions within 48 hours after tracheostomy with a median transfusion of 2 units (IQR, 1-3). There was no procedural mortality. Overall, 88 (69%) patients survived to decannulation and 74 (58%) survived to hospital discharge. Our experience with the largest published series of tracheostomies during ECMO demonstrates that excellent outcomes can be achieved without significant morbidity.Keywords
This publication has 16 references indexed in Scilit:
- Safety of Percutaneous Dilatational Tracheostomy During Veno-Venous Extracorporeal Membrane Oxygenation Support in Adults With Severe Respiratory FailureCritical Care Medicine, 2019
- Bleeding Complications Associated With Percutaneous Tracheostomy Insertion in Patients Supported With Venovenous Extracorporeal Membrane Oxygen Support: A 10-Year Institutional ExperienceJournal of Cardiothoracic and Vascular Anesthesia, 2018
- Early mobilization of patients receiving extracorporeal membrane oxygenation: a retrospective cohort studyCritical Care, 2014
- Safety of percutaneous dilatational tracheostomy in patients on extracorporeal lung supportIntensive Care Medicine, 2013
- Coagulation Disorders Do Not Increase the Risk for Bleeding during Percutaneous Dilatational TracheotomyThe Thoracic and Cardiovascular Surgeon, 2013
- Tracheostomy practice in adults with acute respiratory failureCritical Care Medicine, 2012
- Anticoagulation management around percutaneous bedside proceduresThe Journal of Trauma and Acute Care Surgery, 2012
- Early Percutaneous Tracheotomy Versus Prolonged Intubation of Mechanically Ventilated Patients After Cardiac SurgeryAnnals of Internal Medicine, 2011
- Tracheotomy: clinical review and guidelinesEuropean Journal of Cardio-Thoracic Surgery, 2007
- Tracheostomy Management in the Chronically Ventilated PatientClinics in Chest Medicine, 2001