Tracheostomy in Critically Ill COVID-19 Patients on Extracorporeal Membrane Oxygenation: A Single-Center Experience

Abstract

Objectives: Novel coronavirus-19 (COVID-19) has led to over 6 million fatalities globally. An estimated 75% of COVID-19 patients who require critical care admission develop acute respiratory distress syndrome (ARDS) needing invasive mechanical ventilation (IMV) and/or extracorporeal membrane oxygenation (ECMO). Due to prolonged ventilation requirements, these patients often also require tracheostomy. We performed a review of clinical outcomes in COVID-19 patients on ECMO at a high-volume tertiary care center in Hamilton, Ontario, Canada. Methodology: We performed a retrospective case series, including 24 adult patients diagnosed with COVID-19 who required IMV, veno-venous (ECMO), and tracheostomy. All patients were included from April to December 2021. We extracted demographic and clinical variables pertaining to the tracheostomy procedure and ECMO therapy. We performed descriptive statistical analyses. This study was approved by the Hamilton Integrated Research Ethics Board (14217-C). Results: We included 24 consecutive patients with COVID-19 who required tracheostomy while undergoing ECMO therapy. The mean age was 49.4 years [standard deviation (SD): 7.33], the majority of patients were male (75%), with mean body mass index of 32 (SD: 8.81). Overall mortality rate was 33.3%. Percutaneous tracheostomy was performed most frequently (83.3%) and, similar to open tracheostomy, was associated with a low rate of perioperative bleeding complications. Within surviving patients, the mean time to IMV weaning and decannulation was 60.2 (SD: 24.6) and 49.4 days (SD: 21.8), respectively. Conclusion: Percutaneous tracheostomy appears to be safe in COVID-19 patients on ECMO and holding anticoagulation 24 hours prior to and after tracheostomy may limit bleeding events in these patients.

Tracheostomy in Critically Ill Patients Due to COVID-19 Before the Vaccine, Cases and Controls<br /> <div> <br /> </div>

“…The many benefits of tracheostomy have led to a global upward trend in the frequency, let us also remember that tracheostomy is not harmless, although in this group no complications are reported, it does not mean that the risk of developing them has ended; complications secondary to the procedure are divided into early and late, the most frequent being bleeding, infection, obstruction of the tracheostomy tube, and injury to the posterior wall of the trachea; at least in this series, we did not have this type of complications, nor bleeding, even though the patients were anticoagulation, anticoagulation was suspended 12 hours before; and other groups with critically ill COVID-19 patients report few complications as well [31], but the tracheal stenosis is still latent; the incidence of and risk factors associated with tracheal stenosis in critically ill patients with COVID-19, who required the tracheostomy, are currently unknow [32]. these authors treated 13 patients with post-COVID-19 tracheal stenosis in a period of a twenty-three months [32]; and these reports are likely to increase [33,34], may become a relevant pathology within the next few years: [35].…”

Outcomes for COVID-19 Patients Undergoing Tracheostomy With or Without Extracorporeal Membrane Oxygenation (ECMO)

“…The authors collected several data points paralleling those of our study, including a mean of 26 days from intubation to tracheostomy, compared to 24 days in our ECMO population, 20 days from ECMO cannulation to tracheostomy versus 14 days in our ECMO population, and a 33% mortality rate, compared with 38% in our ECMO population. Their population had a total length of stay of 119 days versus 84 days in our ECMO group, though there are surely a multitude of confounding factors contributing to this [ 24 ]. Another noteworthy recent study, which is one that most closely resembles ours, is that by Son et al [ 25 ].…”