Tracheostomy in high-risk patients on ECMO: A bedside hybrid dilational technique utilizing a Rummel tourniquet.

Autor:	Donato BB; Mayo Clinic, Department of Surgery, Phoenix, AZ, United States of America.; Medical College of Wisconsin, Division of Cardiothoracic Surgery, Milwaukee, WI, United States of America., Sewell M; Oregon Health and Science University, Department of General Surgery, Portland, OR, United States of America., Campany M; Mayo Clinic Alix School of Medicine, Scottsdale, AZ, United States of America., Han GR; Mayo Clinic, Department of Surgery, Phoenix, AZ, United States of America., Orton TS; Mayo Clinic, Department of Surgery, Phoenix, AZ, United States of America., Laitinen M; Mayo Clinic, Department of Surgery, Phoenix, AZ, United States of America., Hammond J; Mayo Clinic, Department of Surgery, Phoenix, AZ, United States of America., Chen X; Mayo Clinic Alix School of Medicine, Scottsdale, AZ, United States of America., Ingersoll J; Mayo Clinic, Department of Cardiothoracic Surgery, Phoenix, AZ, United States of America., Sen A; Mayo Clinic, Department of Critical Care Medicine, Phoenix, AZ, United States of America., D'Cunha J; Mayo Clinic, Department of Cardiothoracic Surgery, Phoenix, AZ, United States of America.
Jazyk:	angličtina
Zdroj:	Surgery open science [Surg Open Sci] 2023 Nov 20; Vol. 16, pp. 248-253. Date of Electronic Publication: 2023 Nov 20 (Print Publication: 2023).
DOI:	10.1016/j.sopen.2023.11.010
Abstrakt:	Objective: Traditionally, critically ill patients requiring prolonged mechanical ventilation benefit from a long-term airway, thus necessitating tracheostomy. The widespread application of extracorporeal membrane oxygenation (ECMO) has exponentially increased in recent years, creating a new subset of patients necessitating tracheostomy with significantly increased bleeding risk. We present a hybrid dilational tracheostomy technique utilizing a Rummel tourniquet developed at our institution to mitigate bleeding risk in patients on ECMO necessitating long-term airway. Methods: A total of 24 patients on ECMO underwent bedside hybrid dilational tracheostomy with utilization of a Rummel tourniquet from 06/2020 to 01/2022 at our institution. These patients were followed longitudinally and evaluated for postoperative bleeding. Particular attention was paid to anticoagulation regimens pre- and post-operatively. Results: The primary outcome of the study, postoperative bleeding, was observed in four of the 24 study participants (16.67 %). Each of these complications were managed with tightening of the Rummel tourniquet and application of hemostatic packing agents; no operative interventions were required. Anticoagulation was held for a mean time of 4.33 h preoperatively and 5.2 h postoperatively. Conclusions: Our data support this hybrid tracheostomy technique with the addition of a Rummel tourniquet to be a safe and effective adjunct for perioperative hemostasis in high-risk patients necessitating tracheostomy while on ECMO. While this technique was initially developed for critically ill COVID-19 patients, we believe it can be applied to all patients on ECMO to help mitigate perioperative bleeding risk. Competing Interests: The authors have no disclosures or conflicts of interest to disclose. (© 2023 The Author(s).)
Databáze:	MEDLINE
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