Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Surgery, New York University Langone Medical Center, New York, NY, USA.
Perfusion. 2022 Jan;37(1):26-30. doi: 10.1177/0267659120979564. Epub 2020 Dec 7.
Extracorporeal membrane oxygenation (ECMO) is increasingly employed in the management of patients with severe cardiac and pulmonary dysfunction. Patients commonly require tracheostomy for ventilator liberation. Though bedside percutaneous tracheostomy is commonly performed, it has the potential for increased complications, both surgical and with the ECMO circuit. We examined surgical outcomes of bedside percutaneous tracheostomy in the ECMO population.
Patients were identified from an institutional database for bedside procedures. Demographics and data on complications were recorded. Descriptive statistics were calculated.
37 patients on ECMO at the time of tracheostomy were identified. Median age and BMI were 43.2 and 28.0, respectively. 33 patients (89%) were on VV ECMO, and 4 (11%) were on VA ECMO. All were on anticoagulation prior to tracheostomy, which was held for 4 h before and after the procedure in all cases. There were no procedure-related deaths or airway losses. No patients experienced periprocedural clotting events of their ECMO circuit or oxygenator within 24 h. 3 patients (8%) required reintervention (re-exploration or bronchoscopy) for bleeding. Four other patients (10%) had minor bleeding controlled with packing. One patient had pneumomediastinum which resolved without intervention, and one had an occlusion of their tracheostomy which was treated with tracheostomy exchange.
Bedside percutaneous tracheostomy is feasible for patients on ECMO. Further study is needed to determine specific risk factors for complications and means to mitigate these. Bedside percutaneous tracheostomy may be considered as part of the management of patients on ECMO to help facilitate liberation from mechanical support.
体外膜肺氧合（ECMO）越来越多地用于治疗严重心肺功能障碍的患者。患者通常需要进行气管切开术以实现呼吸机脱机。虽然床边经皮气管切开术通常可以进行，但它具有增加手术和 ECMO 回路并发症的潜力。我们研究了 ECMO 患者床边经皮气管切开术的手术结果。
从机构数据库中确定床边手术的患者。记录人口统计学数据和并发症数据。计算描述性统计数据。
在气管切开术时，有 37 名 ECMO 患者被确定。中位年龄和 BMI 分别为 43.2 和 28.0。33 名患者（89％）接受 VV ECMO，4 名患者（11％）接受 VA ECMO。所有患者在气管切开术之前均接受抗凝治疗，在所有情况下，在手术前后均暂停抗凝 4 小时。无手术相关死亡或气道损失。没有患者在 24 小时内经历 ECMO 回路或氧合器的围手术期凝块事件。3 名患者（8％）因出血需要再次介入（重新探查或支气管镜检查）。其他 4 名患者（10％）出现轻微出血，用填塞物控制。一名患者发生纵隔气肿，无需干预即可自行缓解，一名患者的气管切开管堵塞，经气管切开管更换治疗。
床边经皮气管切开术在 ECMO 患者中是可行的。需要进一步研究以确定并发症的特定危险因素和减轻这些危险因素的方法。床边经皮气管切开术可作为 ECMO 患者管理的一部分，以帮助实现从机械支持中脱机。
