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Updated: Jul 31, 2025

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
A technique for a bloodless tracheostomy in an anticoagulated patient on extracorporeal membrane oxygenation
Ross D Hoffman1, Abdullah Alshammari2, Yadav Srinivasan2
1Division of Thoracic Surgery, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
Abstract:
A tracheostomy is a commonly indicated procedure for ventilated patients with respiratory failure expected to have a prolonged ventilator wean. In patients who are fully anticoagulated and on extracorporeal membrane oxygenation, it is our practice to perform a tracheostomy with a surgical technique rather than to ensure haemostasis percutaneously. A surgical tracheostomy is a safe procedure for patients on extracorporeal membrane oxygenation, provided it is being done in an experienced centre. If the risk of interrupting anticoagulation permits, we stop the unfractionated heparin infusion 4 hours prior to the procedure. This video tutorial describes the principles of a surgical tracheostomy, our bloodless technique and the relevant anatomy and equipment.
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