Tracheostomy management in patients with severe acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: an International Multicenter Retrospective Study
Matthieu Schmidt,
Christoph Fisser,
Gennaro Martucci,
Darryl Abrams,
Thomas Frapard,
Konstantin Popugaev,
Antonio Arcadipane,
Bianca Bromberger,
Giovanni Lino,
Alexis Serra,
Sacha Rozencwajg,
Matthias Lubnow,
Sergey Petrikov,
Thomas Mueller,
Alain Combes,
Tài Pham,
Daniel Brodie,
for the International ECMO Network (ECMONet)
Affiliations
Matthieu Schmidt
Sorbonne Université, Paris 06, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition
Christoph Fisser
Department of Internal Medicine II, University Hospital Regensburg
Gennaro Martucci
IRCCS-ISMETT Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione - Department of Anesthesia and Intensive Care
Darryl Abrams
Department of Medicine, Columbia University College of Physicians & Surgeons
Thomas Frapard
Assistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière Hospital, Medical Intensive Care Unit
Konstantin Popugaev
Sklifosovsky Research Institute of Emergency Medicine
Antonio Arcadipane
IRCCS-ISMETT Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione - Department of Anesthesia and Intensive Care
Bianca Bromberger
Center for Acute Respiratory Failure, New York-Presbyterian Hospital
Giovanni Lino
IRCCS-ISMETT Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione - Department of Anesthesia and Intensive Care
Alexis Serra
Center for Acute Respiratory Failure, New York-Presbyterian Hospital
Sacha Rozencwajg
Assistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière Hospital, Medical Intensive Care Unit
Matthias Lubnow
Department of Internal Medicine II, University Hospital Regensburg
Sergey Petrikov
Sklifosovsky Research Institute of Emergency Medicine
Thomas Mueller
Department of Internal Medicine II, University Hospital Regensburg
Alain Combes
Sorbonne Université, Paris 06, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition
Tài Pham
Université Paris-Saclay, AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Groupe de Recherche Clinique CARMAS
Daniel Brodie
Department of Medicine, Columbia University College of Physicians & Surgeons
Abstract Background Current practices regarding tracheostomy in patients treated with extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome are unknown. Our objectives were to assess the prevalence and the association between the timing of tracheostomy (during or after ECMO weaning) and related complications, sedative, and analgesic use. Methods International, multicenter, retrospective study in four large volume ECMO centers during a 9-year period. Results Of the 1,168 patients treated with ECMO for severe ARDS (age 48 ± 16 years, 76% male, SAPS II score 51 ± 18) during the enrollment period, 353 (30%) and 177 (15%) underwent tracheostomy placement during or after ECMO, respectively. Severe complications were uncommon in both groups. Local bleeding within 24 h of tracheostomy was four times more frequent during ECMO (25 vs 7% after ECMO, p < 0.01). Cumulative sedative consumption decreased more rapidly after the procedure with sedative doses almost negligible 48–72 h later, when tracheostomy was performed after ECMO decannulation (p < 0.01). A significantly increased level of consciousness was observed within 72 h after tracheostomy in the “after ECMO” group, whereas it was unchanged in the “during-ECMO” group. Conclusion In contrast to patients undergoing tracheostomy after ECMO decannulation, tracheostomy during ECMO was neither associated with a decrease in sedation and analgesia levels nor with an increase in the level of consciousness. This finding together with a higher risk of local bleeding in the days following the procedure reinforces the need for a case-by-case discussion on the balance between risks and benefits of tracheotomy when performed during ECMO.
