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Optimal timing of tracheostomy in patients on veno-venous extracorporeal membrane oxygenation for coronavirus 2019: a case series.
Matsuyoshi, Takeo; Shimizu, Keiki; Kaneko, Hitoshi; Kohsen, Daiyu; Suzuki, Hiroaki; Sato, Yuichi; Hamaguchi, Jun.
  • Matsuyoshi T; Department of Critical Care and Emergency Medicine Tokyo Metropolitan Tama Medical Center Fuchu Tokyo Japan.
  • Shimizu K; Department of Critical Care and Emergency Medicine Tokyo Metropolitan Tama Medical Center Fuchu Tokyo Japan.
  • Kaneko H; Department of Critical Care and Emergency Medicine Tokyo Metropolitan Tama Medical Center Fuchu Tokyo Japan.
  • Kohsen D; Department of Critical Care and Emergency Medicine Tokyo Metropolitan Tama Medical Center Fuchu Tokyo Japan.
  • Suzuki H; Department of Critical Care and Emergency Medicine Tokyo Metropolitan Tama Medical Center Fuchu Tokyo Japan.
  • Sato Y; Department of Critical Care and Emergency Medicine Tokyo Metropolitan Tama Medical Center Fuchu Tokyo Japan.
  • Hamaguchi J; Department of Critical Care and Emergency Medicine Tokyo Metropolitan Tama Medical Center Fuchu Tokyo Japan.
Acute Med Surg ; 8(1): e662, 2021.
Article in English | MEDLINE | ID: covidwho-1233166
Semantic information from SemMedBD (by NLM)
1. Tracheostomy procedure TREATS Patients
Subject
Tracheostomy procedure
Predicate
TREATS
Object
Patients
2. Venovenous ECMO TREATS COVID-19
Subject
Venovenous ECMO
Predicate
TREATS
Object
COVID-19
3. Venovenous ECMO TREATS Patients
Subject
Venovenous ECMO
Predicate
TREATS
Object
Patients
4. Venovenous ECMO ADMINISTERED_TO Patients
Subject
Venovenous ECMO
Predicate
ADMINISTERED_TO
Object
Patients
5. Percutaneous tracheostomy ADMINISTERED_TO Patients
Subject
Percutaneous tracheostomy
Predicate
ADMINISTERED_TO
Object
Patients
6. hemorrhage as a complication PROCESS_OF Patients
Subject
hemorrhage as a complication
Predicate
PROCESS_OF
Object
Patients
7. Tracheostomy procedure ADMINISTERED_TO Patients
Subject
Tracheostomy procedure
Predicate
ADMINISTERED_TO
Object
Patients
8. Tracheostomy procedure TREATS hemorrhage as a complication
Subject
Tracheostomy procedure
Predicate
TREATS
Object
hemorrhage as a complication
9. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
10. Tracheostomy procedure TREATS Patients
Subject
Tracheostomy procedure
Predicate
TREATS
Object
Patients
11. Venovenous ECMO TREATS COVID-19
Subject
Venovenous ECMO
Predicate
TREATS
Object
COVID-19
12. Venovenous ECMO TREATS Patients
Subject
Venovenous ECMO
Predicate
TREATS
Object
Patients
13. Venovenous ECMO ADMINISTERED_TO Patients
Subject
Venovenous ECMO
Predicate
ADMINISTERED_TO
Object
Patients
14. Percutaneous tracheostomy ADMINISTERED_TO Patients
Subject
Percutaneous tracheostomy
Predicate
ADMINISTERED_TO
Object
Patients
15. hemorrhage as a complication PROCESS_OF Patients
Subject
hemorrhage as a complication
Predicate
PROCESS_OF
Object
Patients
16. Tracheostomy procedure ADMINISTERED_TO Patients
Subject
Tracheostomy procedure
Predicate
ADMINISTERED_TO
Object
Patients
17. Tracheostomy procedure TREATS hemorrhage as a complication
Subject
Tracheostomy procedure
Predicate
TREATS
Object
hemorrhage as a complication
18. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
ABSTRACT

AIM:

An early tracheostomy is often considered for patients with veno-venous extracorporeal membrane oxygenation (VV-ECMO). However, there is no consensus on the timing of a tracheostomy in patients on VV-ECMO for coronavirus disease 2019 (COVID-19). The present report described the optimal timing of tracheostomy for these patients.

METHOD:

The present study was a single-center case series. We retrospectively reviewed the medical records of nine consecutive patients who underwent tracheostomy either during or after VV-ECMO treatment in our center between January 1, 2020 and December 31, 2020.

RESULTS:

All the patients received a percutaneous dilatational tracheostomy, which was performed during VV-ECMO in four patients. Three of these patients experienced hemorrhagic complications, and the remaining patient required a circuit change on the day after the operation. Heparin was discontinued 8 h preoperatively and resumed 1-14 h later. The platelet count was below normal in two patients, but no transfusion was performed. APTT was almost normal, and D-dimer was elevated postoperatively. The remaining five patients received a tracheostomy after weaning off VV-ECMO, and no complication was observed. Eight patients were deeply sedated during VV-ECMO to prioritize lung rest and prevent infecting the healthcare workers.

CONCLUSION:

In the present study, patients who underwent a tracheostomy during VV-ECMO tended to have more hemorrhagic complications. Because an early tracheostomy during ECMO has little benefit for patients with COVID-19, it should be performed after weaning off VV-ECMO to protect the safety of the healthcare workers concerned.
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Full text: Available Collection: International databases Database: MEDLINE Language: English Journal: Acute Med Surg Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Language: English Journal: Acute Med Surg Year: 2021 Document Type: Article