Safety of tracheostomy during extracorporeal membrane oxygenation support: A single-center experience.
COVID-19
bleeding
extracorporeal membrane oxygenation
percutaneous tracheostomy
surgical tracheostomy
Journal
Artificial organs
ISSN: 1525-1594
Titre abrégé: Artif Organs
Pays: United States
ID NLM: 7802778
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
revised:
09
08
2023
received:
15
02
2023
accepted:
11
08
2023
medline:
15
11
2023
pubmed:
23
8
2023
entrez:
23
8
2023
Statut:
ppublish
Résumé
Some patients on extracorporeal membrane oxygenation (ECMO) require prolonged mechanical ventilation. An early tracheostomy strategy while on ECMO has appeared to be beneficial for these patients. This study aims to explore the safety of tracheostomy in ECMO patients. This is a retrospective observational single-center study. Hundred and nine patients underwent tracheostomy (76 percutaneous and 33 surgical) during V-V ECMO support over an 8-year period. Patients with a percutaneous tracheostomy showed a significantly shorter ECMO duration [25.5 (17.3-40.1) vs 37.2 (26.5-53.2) days, p = 0.013] and a shorter ECMO-to-tracheostomy time [13.3 (8.5-19.7) vs 27.8 (16.3-36.9) days, p < 0.001] compared to those who underwent a surgical approach. There was no difference between the two strategies regarding both major and minor/no bleeding (p = 0.756). There was no difference in survival rate between patients who underwent percutaneous or surgical tracheostomy (p = 0.173). Patients who underwent an early tracheostomy (within 10 days from ECMO insertion) showed a significantly shorter hospital stay (p < 0.001) and a shorter duration of V-V ECMO support (p < 0.001). Our series includes 24 patients affected by COVID-19, who did not show significantly higher rates of major bleeding when compared to non-COVID-19 patients (p = 0.297). Within the COVID-19 subgroup, there was no difference in major bleeding rates between surgical and percutaneous approach (p = 1.0). Percutaneous and surgical tracheostomy during ECMO have a similar safety profile in terms of bleeding risk and mortality. Percutaneous tracheostomy may favor a shorter duration of ECMO support and hospital stay and can be considered a safe alternative to surgical tracheostomy, even in COVID-19 patients, if relevant clinical expertise is available.
Sections du résumé
BACKGROUND
BACKGROUND
Some patients on extracorporeal membrane oxygenation (ECMO) require prolonged mechanical ventilation. An early tracheostomy strategy while on ECMO has appeared to be beneficial for these patients. This study aims to explore the safety of tracheostomy in ECMO patients.
METHODS
METHODS
This is a retrospective observational single-center study.
RESULTS
RESULTS
Hundred and nine patients underwent tracheostomy (76 percutaneous and 33 surgical) during V-V ECMO support over an 8-year period. Patients with a percutaneous tracheostomy showed a significantly shorter ECMO duration [25.5 (17.3-40.1) vs 37.2 (26.5-53.2) days, p = 0.013] and a shorter ECMO-to-tracheostomy time [13.3 (8.5-19.7) vs 27.8 (16.3-36.9) days, p < 0.001] compared to those who underwent a surgical approach. There was no difference between the two strategies regarding both major and minor/no bleeding (p = 0.756). There was no difference in survival rate between patients who underwent percutaneous or surgical tracheostomy (p = 0.173). Patients who underwent an early tracheostomy (within 10 days from ECMO insertion) showed a significantly shorter hospital stay (p < 0.001) and a shorter duration of V-V ECMO support (p < 0.001). Our series includes 24 patients affected by COVID-19, who did not show significantly higher rates of major bleeding when compared to non-COVID-19 patients (p = 0.297). Within the COVID-19 subgroup, there was no difference in major bleeding rates between surgical and percutaneous approach (p = 1.0).
CONCLUSIONS
CONCLUSIONS
Percutaneous and surgical tracheostomy during ECMO have a similar safety profile in terms of bleeding risk and mortality. Percutaneous tracheostomy may favor a shorter duration of ECMO support and hospital stay and can be considered a safe alternative to surgical tracheostomy, even in COVID-19 patients, if relevant clinical expertise is available.
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1762-1772Informations de copyright
© 2023 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.
Références
Heffner JE, Hess D. Tracheostomy management in the chronically ventilated patient. Clin Chest Med. 2001;22(1):55-69.
Siempos II, Ntaidou TK, Filippidis FT, Choi AMK. Effect of early versus late or no tracheostomy on mortality and pneumonia of critically ill patients receiving mechanical ventilation: a systematic review and meta-analysis. Lancet Respir Med. 2015;3(2):150-158.
Swol J, Strauch JT, Schildhauer TA. Tracheostomy as a bridge to spontaneous breathing and awake-ECMO in non-transplant surgical patients. Eur J Heart Fail. 2017;19(Suppl 2):120-123.
Abrams D, Javidfar J, Farrand E, Mongero LB, Agerstrand CL, Ryan P, et al. Early mobilization of patients receiving extracorporeal membrane oxygenation: a retrospective cohort study. Crit Care. 2014;18(1):R38.
Brodie D, Slutsky AS, Combes A. Extracorporeal life support for adults with respiratory failure and related indications: a review. JAMA. 2019;322(6):557-568.
Zangrillo A, Landoni G, Biondi-Zoccai G, Greco M, Greco T, Frati G, et al. A meta-analysis of complications and mortality of extracorporeal membrane oxygenation. Crit Care Resusc. 2013;15(3):172-178.
Kruit N, Valchanov K, Blaudszun G, Fowles JA, Vuylsteke A. Bleeding complications associated with percutaneous tracheostomy insertion in patients supported with venovenous extracorporeal membrane oxygen support: a 10-year institutional experience. J Cardiothorac Vasc Anesth. 2018;32(3):1162-1166.
Leentjens J, van Haaps TF, Wessels PF, Schutgens REG, Middeldorp S. COVID-19-associated coagulopathy and antithrombotic agents-lessons after 1 year. Lancet Haematol. 2021;8(7):e524-e533.
Warren A, Chiu YD, Villar SS, Fowles JA, Symes N, Barker J, et al. Outcomes of the NHS England National Extracorporeal Membrane Oxygenation Service for adults with respiratory failure: a multicentre observational cohort study. Br J Anaesth. 2020;125(3):259-266.
Garfield B, Bianchi P, Arachchillage D, Hartley P, Naruka V, Shroff D, et al. Six-month mortality in patients with COVID-19 and non-COVID-19 viral pneumonitis managed with veno-venous extracorporeal membrane oxygenation. ASAIO J. 2021;67:982-988.
Dimopoulos S, Joyce H, Camporota L, Glover G, Ioannou N, Langrish CJ, et al. Safety of percutaneous dilatational tracheostomy during veno-venous extracorporeal membrane oxygenation support in adults with severe respiratory failure. Crit Care Med. 2019;47(2):e81-e88.
Smith MC, Evans PT, Prendergast KM, Schneeberger SJ, Henson CP, McGrane S, et al. Surgical outcomes and complications of bedside tracheostomy in the ICU for patients on ECMO. Perfusion. 2020;37(1):26-30.
Grewal J, Sutt AL, Cornmell G, Shekar K, Fraser J. Safety and putative benefits of tracheostomy tube placement in patients on extracorporeal membrane oxygenation: a single-center experience. J Intensive Care Med. 2020;35(11):1153-1161.
Braune S, Kienast S, Hadem J, Wiesner O, Wichmann D, Nierhaus A, et al. Safety of percutaneous dilatational tracheostomy in patients on extracorporeal lung support. Intensive Care Med. 2013;39(10):1792-1799.
Salna M, Tipograf Y, Liou P, Chicotka S, Biscotti M 3rd, Agerstrand C, et al. Tracheostomy is safe during extracorporeal membrane oxygenation support. ASAIO J. 2020;66(6):652-656.
Langer T, Santini A, Bottino N, Crotti S, Batchinsky AI, Pesenti A, et al. “Awake” extracorporeal membrane oxygenation (ECMO): pathophysiology, technical considerations, and clinical pioneering. Crit Care. 2016;20(1):150.
Swol J, Shekar K, Protti A, Tukacs M, Broman LM, Barrett NA, et al. Extubate before venovenous extracorporeal membranous oxygenation decannulation or decannulate while remaining on the ventilator? The EuroELSO 2019 weaning survey. ASAIO J. 2021;67(4):e86-e89.
Lubnow M, Philipp A, Dornia C, Schroll S, Bein T, Creutzenberg M, et al. D-dimers as an early marker for oxygenator exchange in extracorporeal membrane oxygenation. J Crit Care. 2014;29(3):473 e1-473 e5.
Schmidt M, Fisser C, Martucci G, Abrams D, Frapard T, Popugaev K, et al. Tracheostomy management in patients with severe acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: an international multicenter retrospective study. Crit Care. 2021;25(1):238.
Delaney A, Bagshaw SM, Nalos M. Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta-analysis. Crit Care. 2006;10(2):R55.
Kohne JG, MacLaren G, Cagino L, Boonstra PS, Brodie D, Barbaro RP. Tracheostomy practices and outcomes in patients with COVID-19 supported by extracorporeal membrane oxygenation: an analysis of the extracorporeal life support organization registry. Crit Care Med. 2022;50(9):1360-1370.
Salas De Armas IA, Dinh K, Akkanti B, Jani P, Hussain R, Janowiak L, et al. Tracheostomy while on extracorporeal membrane oxygenation: a comparison of percutaneous and open procedures. J Extra Corpor Technol. 2020;52(4):266-271.
Chorath K, Hoang A, Rajasekaran K, Moreira A. Association of early vs late tracheostomy placement with pneumonia and ventilator days in critically ill patients: a meta-analysis. JAMA Otolaryngol Head Neck Surg. 2021;147(5):450-459.
Young D, Harrison DA, Cuthbertson BH, Rowan K, TracMan C. Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA. 2013;309(20):2121-2129.
DiChiacchio L, Boulos FM, Brigante F, Raithel M, Shah A, Pasrija C, et al. Early tracheostomy after initiation of venovenous extracorporeal membrane oxygenation is associated with decreased duration of extracorporeal membrane oxygenation support. Perfusion. 2020;35(6):509-514.
Lusebrink E, Stark K, Bertlich M, Kupka D, Stremmel C, Scherer C, et al. Safety of percutaneous dilatational tracheotomy in patients on dual antiplatelet therapy and anticoagulation. Crit Care Explor. 2019;1(10):e0050.
Matsuyoshi T, Shimizu K, Kaneko H, Kohsen D, Suzuki H, Sato Y, et al. Optimal timing of tracheostomy in patients on veno-venous extracorporeal membrane oxygenation for coronavirus 2019: a case series. Acute Med Surg. 2021;8(1):e662.
Tuzemen G, Kaya PK. Aerosol-generating procedure; percutaneous versus surgical tracheostomy. Am J Otolaryngol. 2022;43(3):103401.
Favier V, Lescroart M, Pequignot B, Grimmer L, Florentin A, Gallet P. Measurement of airborne particle emission during surgical and percutaneous dilatational tracheostomy COVID-19 adapted procedures in a swine model: experimental report and review of literature. PloS One. 2022;17(11):e0278089.
Rossetti M, Vitiello C, Campitelli V, Cuffaro R, Bianco C, Martucci G, et al. Apneic tracheostomy in COVID-19 patients on veno-venous extracorporeal membrane oxygenation. Membranes (Basel). 2021;11(7):502.