Early Tracheostomy in Patients Requiring Venovenous Extracorporeal Membrane Oxygenation

Early tracheostomy (ET) can decrease length of stay and mortality. The benefits of ET in patients requiring venovenous (VV) extracorporeal membrane oxygenation (ECMO) remain contentious. We assessed the influence of ET on outcomes in patients requiring VV ECMO.

We queried a multiinstitutional ECMO registry to evaluate patients requiring VV ECMO for severe acute respiratory distress syndrome and compared outcomes between ET and late tracheostomy (LT) groups. Outcomes of interest included time to decannulation, extubation, discharge, survival, hospital, and intensive care unit length of stay (LOS). Univariate analyses of continuous and categorical variables were performed using t tests and χ² tests where appropriate. Multistate Cox proportional hazards models and generalized linear models were used for multivariable analysis.

Our sample comprised 133 patients, 88 who underwent ET and 45 who underwent LT. Patients who underwent ET were younger (P = .046), had a higher body mass index (P = .046), and had higher respiratory ECMO survival prediction (RESP) scores (P < .001). The number of days from ECMO to tracheostomy was 1.65 ± 1.26 days in the ET group and 13.6 ± 10 days in the LT group. There were no statistically significant differences in time to decannulation between the 2 groups. Univariate analysis demonstrated that patients with ET had a shorter interval and higher survival to extubation. Multivariable analysis demonstrated that patients with ET had a shorter duration to extubation (P = .03), time to discharge (P = .013), intensive care unit LOS (P = .012), and hospital LOS (P = .044). There was no significant difference in survival (P = .83) or time to decannulation (P = .12) between the 2 cohorts.

Extracorporeal support involves high-intensity resource use. ET in patients requiring VV ECMO may improve outcomes and decrease resource consumption.