21668RA Cowley Shock Trauma Center at the University of Maryland Medical Center, Baltimore, MD, USA.
12264University of Maryland School of Medicine, Baltimore, MD, USA.
Am Surg. 2021 Aug;87(8):1292-1298. doi: 10.1177/0003134820979595. Epub 2020 Dec 19.
The anticoagulation and coagulopathy associated with venovenous extracorporeal membrane oxygenation (VV-ECMO) lead to concern for increased risks of tracheostomy. The purpose of this study is to evaluate the safety of tracheostomy in patients on VV-ECMO.
Patients admitted between November 2015 and January 2019 to a dedicated intensive care unit for VV-ECMO were reviewed retrospectively.
96 patients underwent tracheostomy. Tracheostomy was performed percutaneously in 51 patients, open in 24, and hybrid in 21. 28 patients had postprocedure bleeding which was from the tracheostomy site in 13, the airway in 13, and both in 2. 6 patients had major tracheostomy site bleeding and 3 patients had major airway bleeding. 7 patients had minor tracheostomy site bleeding, 10 patients had minor airway bleeding, and 2 patients had minor bleeding at both. Bleeding complications were more common following percutaneous tracheostomy. Being on anticoagulation prior to tracheostomy was protective.
Bleeding following tracheostomy in VV-ECMO is common with higher bleeding rates observed for those done percutaneously. Most complications were minor. Tracheostomy in patients on VV-ECMO appears safe.
与静脉-静脉体外膜肺氧合（VV-ECMO）相关的抗凝和凝血异常导致人们担心气管切开术的风险增加。本研究的目的是评估 VV-ECMO 患者行气管切开术的安全性。
回顾性分析 2015 年 11 月至 2019 年 1 月期间在专门的重症监护病房接受 VV-ECMO 的患者。
96 例患者行气管切开术。51 例患者行经皮气管切开术，24 例行开放式，21 例行混合式。28 例患者术后有出血，其中 13 例为气管切开部位出血，13 例为气道出血，2 例为两者均有出血。6 例患者有主要气管切开部位出血，3 例患者有主要气道出血。7 例患者有轻微气管切开部位出血，10 例患者有轻微气道出血，2 例患者两者均有轻微出血。经皮气管切开术后出血并发症更为常见。气管切开术前使用抗凝剂有保护作用。
VV-ECMO 患者行气管切开术后出血常见，经皮气管切开术出血率较高。大多数并发症为轻微。VV-ECMO 患者行气管切开术似乎是安全的。
