Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK.
Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK.
Artif Organs. 2023 Nov;47(11):1762-1772. doi: 10.1111/aor.14633. Epub 2023 Aug 23.
Some patients on extracorporeal membrane oxygenation (ECMO) require prolonged mechanical ventilation. An early tracheostomy strategy while on ECMO has appeared to be beneficial for these patients. This study aims to explore the safety of tracheostomy in ECMO patients.
This is a retrospective observational single-center study.
Hundred and nine patients underwent tracheostomy (76 percutaneous and 33 surgical) during V-V ECMO support over an 8-year period. Patients with a percutaneous tracheostomy showed a significantly shorter ECMO duration [25.5 (17.3-40.1) vs 37.2 (26.5-53.2) days, p = 0.013] and a shorter ECMO-to-tracheostomy time [13.3 (8.5-19.7) vs 27.8 (16.3-36.9) days, p < 0.001] compared to those who underwent a surgical approach. There was no difference between the two strategies regarding both major and minor/no bleeding (p = 0.756). There was no difference in survival rate between patients who underwent percutaneous or surgical tracheostomy (p = 0.173). Patients who underwent an early tracheostomy (within 10 days from ECMO insertion) showed a significantly shorter hospital stay (p < 0.001) and a shorter duration of V-V ECMO support (p < 0.001). Our series includes 24 patients affected by COVID-19, who did not show significantly higher rates of major bleeding when compared to non-COVID-19 patients (p = 0.297). Within the COVID-19 subgroup, there was no difference in major bleeding rates between surgical and percutaneous approach (p = 1.0).
Percutaneous and surgical tracheostomy during ECMO have a similar safety profile in terms of bleeding risk and mortality. Percutaneous tracheostomy may favor a shorter duration of ECMO support and hospital stay and can be considered a safe alternative to surgical tracheostomy, even in COVID-19 patients, if relevant clinical expertise is available.
一些接受体外膜肺氧合（ECMO）治疗的患者需要长时间接受机械通气。在 ECMO 治疗期间尽早进行气管切开术似乎对这些患者有益。本研究旨在探讨 ECMO 患者行气管切开术的安全性。
这是一项回顾性观察性单中心研究。
在 8 年期间，109 名患者在 V-V ECMO 支持期间接受了气管切开术（76 例经皮和 33 例手术）。与手术方法相比，经皮气管切开术患者的 ECMO 持续时间明显更短[25.5（17.3-40.1）vs 37.2（26.5-53.2）天，p=0.013]，ECMO 到气管切开术的时间也更短[13.3（8.5-19.7）vs 27.8（16.3-36.9）天，p<0.001]。两种策略之间在主要和次要/无出血方面没有差异（p=0.756）。经皮和手术气管切开术患者的生存率无差异（p=0.173）。早期气管切开术（ECMO 插入后 10 天内）的患者住院时间明显更短（p<0.001），V-V ECMO 支持时间也更短（p<0.001）。我们的系列研究包括 24 名 COVID-19 患者，与非 COVID-19 患者相比，他们的主要出血发生率并没有明显升高（p=0.297）。在 COVID-19 亚组中，手术和经皮方法的主要出血率无差异（p=1.0）。
在 ECMO 治疗期间，经皮和手术气管切开术在出血风险和死亡率方面具有相似的安全性。经皮气管切开术可能有利于 ECMO 支持时间和住院时间更短，如果有相关临床专业知识，即使是 COVID-19 患者，也可以考虑作为手术气管切开术的安全替代方法。
