Korean J Crit Care Med.  2017 May;32(2):197-204. 10.4266/kjccm.2017.00059.

Safety of Surgical Tracheostomy during Extracorporeal Membrane Oxygenation

• Yeo HJ
• Yoon SH
• Lee SE
• Jeon D
• Kim YS
• Cho WH
• Kim D

• KMID: 2384045
• DOI: http://doi.org/10.4266/kjccm.2017.00059

Abstract

BACKGROUND
The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO.
METHODS
From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST.
RESULTS
Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×109/L (range, 46 to 434 ×109/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST.
CONCLUSIONS
The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.

Keyword

anticoagulation; bleeding; extracorporeal membrane oxygenation; tracheostomy

MeSH Terms

Anticoagulants
Critical Illness
Extracorporeal Membrane Oxygenation*
Hemorrhage
Hemostasis, Surgical
Heparin
Humans
International Normalized Ratio
Medical Records
Partial Thromboplastin Time
Platelet Count
Retrospective Studies
Tracheostomy*
Anticoagulants
Heparin

Figure

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  Figure 1. Differences in clinical outcomes between early and late tracheostomy in patients on extracorporeal membrane oxygenation. Values are presented as the median day. MV: mechanical ventilator; ICU: intensive care unit.

Reference

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