ABSTRACT
Objective: Extracorporeal membrane oxygenation (ECMO) use in COVID-19 has been supported by major health organizations and studies, but optimal management strategies need further research. We characterize and describe the tracheostomy practice in ECMO-supported patients with acute respiratory failure related to viral pneumonia without SARS-CoV-2 in 2019 and to COVID-19 in 2020. Methods: Analysis of the Extracorporeal Life Support Organization (ELSO) Registry including patients receiving respiratory ECMO support for COVID-19 in 2020 or other viral-induced respiratory failure in 2019. We compared tracheostomy practices between the 2019 and 2020 cohorts and reported outcomes of those that receive a tracheostomy on ECMO. Results: We identified 1960 patients who received VV-ECMO support for acute respiratory failure related to COVID-19. 57% of patients received a tracheostomy during the hospitalization, and 25% had a tracheostomy placed while on ECMO. The proportion of patients receiving a tracheostomy was similar in 2019 viral disease, but tracheostomies were performed 4 days earlier in 2019 compared to 2020 (median 6.7 days [IQR 3.0- 12.0 days] vs. 11.2 days [IQR 5.8-17.0 days], p< 0.01). More patients were mobilized in 2019 than 2020, but patients who received a tracheostomy on ECMO were more likely to be mobilized in both cohorts. 8% of patients were reported as having surgical site bleeding after a tracheostomy placement on ECMO in 2020. The median ECMO duration in those who received a tracheostomy on ECMO was 23.5 days [IQR 15.8-35.3]. Hospital mortality was 45% for patients with COVID- 19 (46% for patients who received a tracheostomy on ECMO). Conclusions: Tracheostomies are commonly performed in COVID-19 patients on ECMO. The number of tracheostomies performed on ECMO in the SARS-CoV-2 pandemic is similar to other viral diseases in 2019, however, they are performed later in the ECMO run. Patients who receive a tracheostomy are more likely to achieve mobilization.