Percutaneous dilatation tracheotomy in patients on extracorporeal membrane oxygenation after cardiac surgery

Abstract

Background

Current practices regarding percutaneous dilatational tracheostomy in adult patients treated with extracorporeal membrane oxygenation (ECMO) after cardiac surgery is not completely defined. This study aimed to evaluate the safety of the percutaneous dilatational tracheostomy in patients with ECMO after cardiac surgery.

Methods

Between July 2017 and May 2021, 371 ECMO procedures were performed in more than 35,000 adult patients who underwent cardiac surgery in our hospital. Sixty-two patients underwent percutaneous dilatational tracheostomy (PDT) during or after ECMO. A retrospective analysis was performed comparing the incidence of complications and clinical outcomes of the two groups.

Results

Of the 371 patients treated with ECMO after adult cardiac surgery during the enrollment period, 22 (7.1%) and 40 (12.8%) underwent PDT during or after ECMO, respectively. The platelet count (PLT) of the day was significantly lower in the PDT during ECMO group (54 (34, 68) vs. 108 (69, 162) (thousands), p < 0.001)). The prothrombin time (PT) and activated partial thromboplastin time (APTT) of the day were longer in the PDT during ECMO group (15.8 (14.6, 19.9) vs. 13.8 (13.2, 15.2) seconds, p = 0.001, 43.8 (38.0, 49.4) vs. 35.2 (28.2, 40.9) seconds, p < 0.001, respectively). There was no significant difference in tracheotomy-related complications between the two groups. Significantly decreased ventilator time was observed in the PDT during ECMO group.

Conclusions

Despite poor coagulation of the day, PDT during ECMO is safe and can appropriately reduce the duration of mechanical ventilation compared with PDT after ECMO weaning in adult patients who have undergone cardiac surgery.

Keywords

ECMO Cardiac surgery Percutaneous dilatational tracheostomy Mechanical ventilation Complication

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References

Denault

Tardif

Mazer

, et al. BART Investigators. Difficult and complex separation from cardiopulmonary bypass in high-risk cardiac surgical patients: a multicenter study. J Cardiothorac Vasc Anesth 2012; 26: 608–616.

Thanavaro

Taylor

Vitt

, et al. Predictors and outcomes of postoperative respiratory failure after cardiac surgery. J Eval Clin Pract 2020; 26: 1490–1497.

Eremenko

Zyulyaeva

. Postoperative acute respiratory failure in cardiac surgery. Khirurgiia (Mosk) 2019; 8: 5–11.

Miyashita

Kinoshita

Suzuki

, et al. Respiratory Failure after Open Descending Aortic Aneurysm Repair: Risk Factors and Outcomes. Ann Thorac Cardiovasc Surg 2021; 27: 41–48.

Khorsandi

Dougherty

Bouamra

, et al. Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery: a systematic review and meta-analysis. J Cardiothorac Surg 2017; 12: 55–68.

Iyengar

Kwon

Bailey

, et al. Predictors of cardiogenic shock in cardiac surgery patients receiving intra-aortic balloon pumps. Surgery 2018; 163: 1317–1323.

Young

Harrison

Cuthbertson

, et al. Efect of early vs late tracheotomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA 2013; 309: 2121–2129.

Kornblith

Burlew

Moore

, et al. One thousand bedside percutaneous tracheostomies in the surgical intensive care unit: time to change the gold standard. J Am Coll Surg 2011; 212: 163–170.

Takahashi

Itagaki

Laskaris

, et al. Percutaneous tracheotomy can be safely performed in patients with uncorrected coagulopathy after cardiothoracic surgery. Innovations (Phila) 2014; 9: 22–26.

10.

Stewart

Giverts

. Mechanical circulatory support for advanced heart failure: patients and technology in evolution. Circulation 2012; 125: 1304–1315.

11.

Rahmanian

Adams

Castillo

, et al. Predicting hospital mortality and analysis of long-term survival after majornoncardiac complications in cardiac surgery patients. Ann Thorac Surg 2010; 90: 1221–1229.

12.

Briggs

Ambler

Smith

. A survey of tracheotomy practice in a cardiothoracic intensive care unit. J Cardiothorac Vasc Anesth 2007; 21: 76–80.

13.

Wang

Pan

Wang

, et al. The impact of tracheotomy timing in critically ill patients undergoing mechanical ventilation: A metaanalysis of randomized controlled clinical trials with trial sequential analysis. Heart Lung 2019; 48: 46–54.

14.

Schmidt

Fisser

Martucci

International ECMO Network (ECMONet) , et al. tracheotomy management in patients with severe acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: an International Multicenter Retrospective Study. Crit Care 2021; 25: 238–249.

15.

Salas De Armas

Dinh

Akkanti

, et al. tracheotomy while on Extracorporeal Membrane Oxygenation: A Comparison of Percutaneous and Open Procedures. J Extra Corpor Technol 2020; 52: 266–271.

16.

Kost

. Endoscopic percutaneous dilatational tracheotomy: A prospective evaluation of 500 consecutive cases. Laryngoscope 2005; 115: 1–30.

17.

Westphal

Byhahn

Rinne

, et al. tracheotomy in cardiosurgical patients: surgical tracheotomy versus Ciaglia and Fantoni methods. Ann Thorac Surg 1999; 68: 486–491.

18.

Bacchetta

Girardi

Southard

, et al. Comparison of open versus bedside percutaneous dilatational tracheotomy in the cardiothoracic surgical patient: outcomes and financial analysis. Ann Thorac Surg 2005; 79(6): 1879–1885.

19.

Chorath

Hoang

Rajasekaran

, et al. Association of early vs late tracheotomy placement with pneumonia and ventilator days in critically ill patients: a meta-analysis. JAMA Otolaryngol Head Neck Surg 2021; 147: 450–459.