Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, MI.
Crit Care Med. 2022 Sep 1;50(9):1360-1370. doi: 10.1097/CCM.0000000000005579. Epub 2022 May 16.
The use of extracorporeal membrane oxygenation (ECMO) in patients with COVID-19 has been supported by major healthcare organizations, yet the role of specific management strategies during ECMO requires further study. We sought to characterize tracheostomy practices, complications, and outcomes in ECMO-supported patients with acute respiratory failure related to COVID-19.
Retrospective cohort study.
ECMO centers contributing to the Extracorporeal Life Support Organization Registry.
Patients 16 years or older receiving venovenous ECMO for respiratory support for: 1) COVID-19 in 2020 and 2021 (through October 2021) and 2) pre-COVID-19 viral pneumonia in 2019.
None.
We identified 7,047 patients who received ECMO support for acute respiratory failure related to COVID-19. A total of 32% of patients were recorded as having a tracheostomy procedure during ECMO, and 51% had a tracheostomy at some point during hospitalization. The frequency of tracheostomy was similar in pre-COVID-19 viral pneumonia, but tracheostomies were performed 3 days earlier compared with patients with COVID-19 (median 6.7 d [interquartile range [IQR], 3.0-12.0 d] vs 10.0 d [IQR, 5.0-16.5 d]; p < 0.001). More patients were mobilized with pre-COVID-19 viral pneumonia, but receipt of a tracheostomy during ECMO was associated with increased mobilization in both cohorts. More bleeding complications occurred in patients who received a tracheostomy, with 9% of patients with COVID-19 who received a tracheostomy reported as having surgical site bleeding.
Tracheostomies are performed in COVID-19 patients receiving ECMO at rates similar to practices in pre-COVID-19 viral pneumonia, although later during the course of ECMO. Receipt of a tracheostomy was associated with increased patient mobilization. Overall mortality was similar between those who did and did not receive a tracheostomy.
主要医疗机构支持将体外膜肺氧合（ECMO）用于 COVID-19 患者，但 ECMO 期间具体管理策略的作用仍需要进一步研究。我们旨在描述与 COVID-19 相关的急性呼吸衰竭接受 ECMO 支持的患者的气管切开术实践、并发症和结局。
回顾性队列研究。
向体外生命支持组织登记处提供 ECMO 支持的 ECMO 中心。
2020 年和 2021 年（截至 2021 年 10 月）期间因 1）COVID-19 和 2）2019 年新冠病毒肺炎接受静脉-静脉 ECMO 呼吸支持的年龄为 16 岁或以上的患者。
无。
我们确定了 7047 名因 COVID-19 相关急性呼吸衰竭接受 ECMO 支持的患者。共有 32%的患者在 ECMO 期间记录有气管切开术，51%的患者在住院期间的某个时间点进行了气管切开术。在新冠病毒肺炎前的病毒性肺炎中，气管切开术的频率相似，但与 COVID-19 患者相比，气管切开术的时间更早（中位数 6.7 d [四分位距 [IQR]，3.0-12.0 d] 比 10.0 d [IQR，5.0-16.5 d]；p < 0.001）。在新冠病毒肺炎前的病毒性肺炎患者中，更多的患者可以被动员，但在两个队列中，在 ECMO 期间进行气管切开术与增加的动员相关。在接受气管切开术的患者中，更多的出血并发症发生，9%的 COVID-19 患者报告有手术部位出血。
在 COVID-19 患者中，气管切开术的实施率与 COVID-19 前病毒性肺炎的实践相似，但在 ECMO 期间进行得较晚。接受气管切开术与增加患者的活动能力有关。是否进行气管切开术与总体死亡率无差异。
