Timing of tracheostomy and patient outcomes in critically ill patients requiring extracorporeal membrane oxygenation: a single-center retrospective observational study

Abstract

Background Extracorporeal membrane oxygenation (ECMO) is an integral method of life support in critically ill patients with severe cardiopulmonary failure; however, such patients generally require prolonged mechanical ventilation and exhibit high mortality rates. Tracheostomy is commonly performed in patients on mechanical ventilation, and its early implementation has potential advantages for favorable patient outcomes. This study aimed to investigate the association between tracheostomy timing and patient outcomes, including mortality, in patients requiring ECMO. Methods We conducted a single-center retrospective observational study of consecutively admitted patients who were supported by ECMO and underwent tracheostomy during intensive care unit (ICU) admission at a tertiary care center from April 2014 until December 2021. The primary outcome was hospital mortality. Using the quartiles of tracheostomy timing, the patients were classified into four groups for comparison. The association between the quartiles of tracheostomy timing and mortality was explored using multivariable logistic regression models. Results Of the 293 patients treated with ECMO, 98 eligible patients were divided into quartiles 1 (≤ 15 days), quartile 2:16–19 days, quartile 3:20–26 days, and 4 (> 26 days). All patients underwent surgical tracheostomy and 35 patients underwent tracheostomy during ECMO. The complications of tracheostomy were comparable between the groups, whereas the duration of ECMO and ICU length of stay increased significantly as the quartiles of tracheostomy timing increased. Patients in quartile 1 had the lowest hospital mortality rate (19.2%), whereas those in quartile 4 had the highest mortality rate (50.0%). Multivariate logistic regression analysis showed a significant association between the increment of the quartiles of tracheostomy timing and hospital mortality (adjusted odds ratio for quartile increment:1.55, 95% confidence interval 1.03–2.35, p for trend = 0.037). Conclusions The timing of tracheostomy in patients requiring ECMO was significantly associated with patient outcomes in a time-dependent manner. Further investigation is warranted to determine the optimal timing of tracheostomy in terms of mortality.

Extracorporeal Membrane Oxygenation Without Invasive Ventilation for Respiratory Failure in Adults: A Systematic Review*

“…Early implementation of this strategy remains attractive. Early tracheostomy could also be considered in this context, and has been suggested to improve outcome (83).…”

Successful management of temporary veno-venous extracorporeal membrane oxygenation for a pediatric lung transplant recipient with bronchiolitis obliterans syndrome awaiting lung re-transplantation: a case report

“…The early initiation of ECMO is believed to have interrupted such a vicious cycle, leading to avoidance of fatal side effects and successful weaning from ECMO. In addition, recent reports have revealed that early tracheostomy after VV ECMO initiation is associated with shorter ECMO support duration and ICU stay and lower hospital mortality rates [ 13 , 14 ]. In this case, the patient underwent tracheostomy on day 5 after VV ECMO initiation and was subsequently weaned off VV ECMO within a short period.…”

Development of a Prognostic Scoring System for Tracheostomized Patients Requiring Prolonged Ventilator Care: A Ten-Year Experience in a University-Affiliated Tertiary Hospital

“…This procedure offers several advantages, including enhanced patient comfort, reduced reliance on sedative agents, accelerated MV weaning, lower incidence of nosocomial pneumonia, and shorter hospital stays [14]. These benefits suggest that an early tracheostomy may have effects on clinical outcomes in patients receiving MV attention [15][16][17][18]. The prospect that patients with long-term MV and tracheostomy may exhibit distinct outcomes underscores the necessity for tailored prognostic models for this specific population.…”