Tracheostomy Is Safe During Extracorporeal Membrane Oxygenation Support

Area of Science:

• Critical Care Medicine
• Cardiovascular Surgery
• Respiratory Medicine

Background:

• Patients on extracorporeal membrane oxygenation (ECMO) often require prolonged mechanical ventilation.
• Tracheostomy in ECMO patients can be challenging due to clinical instability and anticoagulation.
• Limited data exists on the safety and outcomes of tracheostomy during ECMO support.

Purpose of the Study:

• To report the experience and outcomes of performing tracheostomies on patients supported by ECMO.
• To evaluate the safety and efficacy of both open and percutaneous tracheostomy techniques in this population.
• To assess procedural complications, transfusion requirements, and survival rates.

Main Methods:

• Retrospective review of 127 patients who underwent tracheostomy during ECMO support from August 2009 to December 2017.
• Data collected included patient demographics, ECMO cannulation type (VV, VA, hybrid), tracheostomy method (open, percutaneous), activated partial thromboplastin time (aPTT), time from ECMO initiation to tracheostomy, and packed red blood cell (pRBC) transfusions.
• Survival to decannulation and hospital discharge were primary outcome measures.

Main Results:

• Percutaneous tracheostomy was the predominant method (87%).
• No procedural mortality was observed.
• Survival to decannulation was 69%, and survival to hospital discharge was 58%.

Conclusions:

• Tracheostomy can be safely performed in patients supported by ECMO.
• Excellent outcomes and survival rates can be achieved with minimal morbidity.
• This study represents the largest published series on tracheostomies during ECMO, supporting its feasibility.