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Tracheostomy Practices and Outcomes in Patients With COVID-19 Supported by Extracorporeal Membrane Oxygenation: An Analysis of the Extracorporeal Life Support Organization Registry.
Kohne, Joseph G; MacLaren, Graeme; Cagino, Leigh; Boonstra, Philip S; Brodie, Daniel; Barbaro, Ryan P.
  • Kohne JG; Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
  • MacLaren G; Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, MI.
  • Cagino L; Cardiothoracic Intensive Care Unit, National University Health System, Singapore.
  • Boonstra PS; Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
  • Brodie D; School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor, MI.
  • Barbaro RP; Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
Crit Care Med ; 50(9): 1360-1370, 2022 09 01.
Article in English | MEDLINE | ID: covidwho-1860940
ABSTRACT

OBJECTIVES:

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.

DESIGN:

Retrospective cohort study.

SETTING:

ECMO centers contributing to the Extracorporeal Life Support Organization Registry. PATIENTS 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.

INTERVENTIONS:

None. MEASUREMENTS AND MAIN

RESULTS:

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.

CONCLUSIONS:

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.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Respiratory Insufficiency / Extracorporeal Membrane Oxygenation / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: Crit Care Med Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Respiratory Insufficiency / Extracorporeal Membrane Oxygenation / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: Crit Care Med Year: 2022 Document Type: Article