Surgical outcomes and complications of bedside tracheostomy in the ICU for patients on ECMO.

Autor:	Smith MC; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Evans PT; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Prendergast KM; Department of Surgery, New York University Langone Medical Center, New York, NY, USA., Schneeberger SJ; Department of Plastic Surgery, Ohio State University, Columbus, OH, USA., Henson CP; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA., McGrane S; Department of Anesthesiology, St. Thomas West Hospital, Nashville, TN, USA., Kopp EB; Department of Nursing, Vanderbilt University Medical Center, Nashville, TN, USA., Collins NE; Office of Advanced Practice, Vanderbilt University Medical Center, Nashville, TN, USA., Guillamondegui OD; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Dennis BM; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Jazyk:	angličtina
Zdroj:	Perfusion [Perfusion] 2022 Jan; Vol. 37 (1), pp. 26-30. Date of Electronic Publication: 2020 Dec 07.
DOI:	10.1177/0267659120979564
Abstrakt:	Objective: Extracorporeal membrane oxygenation (ECMO) is increasingly employed in the management of patients with severe cardiac and pulmonary dysfunction. Patients commonly require tracheostomy for ventilator liberation. Though bedside percutaneous tracheostomy is commonly performed, it has the potential for increased complications, both surgical and with the ECMO circuit. We examined surgical outcomes of bedside percutaneous tracheostomy in the ECMO population. Methods: Patients were identified from an institutional database for bedside procedures. Demographics and data on complications were recorded. Descriptive statistics were calculated. Results: 37 patients on ECMO at the time of tracheostomy were identified. Median age and BMI were 43.2 and 28.0, respectively. 33 patients (89%) were on VV ECMO, and 4 (11%) were on VA ECMO. All were on anticoagulation prior to tracheostomy, which was held for 4 h before and after the procedure in all cases. There were no procedure-related deaths or airway losses. No patients experienced periprocedural clotting events of their ECMO circuit or oxygenator within 24 h. 3 patients (8%) required reintervention (re-exploration or bronchoscopy) for bleeding. Four other patients (10%) had minor bleeding controlled with packing. One patient had pneumomediastinum which resolved without intervention, and one had an occlusion of their tracheostomy which was treated with tracheostomy exchange. Conclusions: Bedside percutaneous tracheostomy is feasible for patients on ECMO. Further study is needed to determine specific risk factors for complications and means to mitigate these. Bedside percutaneous tracheostomy may be considered as part of the management of patients on ECMO to help facilitate liberation from mechanical support.
Databáze:	MEDLINE
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