PMID- 35607973 OWN - NLM STAT- MEDLINE DCOM- 20220822 LR - 20230203 IS - 1530-0293 (Electronic) IS - 0090-3493 (Print) IS - 0090-3493 (Linking) VI - 50 IP - 9 DP - 2022 Sep 1 TI - Tracheostomy Practices and Outcomes in Patients With COVID-19 Supported by Extracorporeal Membrane Oxygenation: An Analysis of the Extracorporeal Life Support Organization Registry. PG - 1360-1370 LID - 10.1097/CCM.0000000000005579 [doi] AB - OBJECTIVES: The use of extracorporeal membrane oxygenation (ECMO) in patients with COVID-19 has been supported by major healthcare organizations, yet the role of specific management strategies during ECMO requires further study. We sought to characterize tracheostomy practices, complications, and outcomes in ECMO-supported patients with acute respiratory failure related to COVID-19. DESIGN: Retrospective cohort study. SETTING: ECMO centers contributing to the Extracorporeal Life Support Organization Registry. PATIENTS: Patients 16 years or older receiving venovenous ECMO for respiratory support for: 1) COVID-19 in 2020 and 2021 (through October 2021) and 2) pre-COVID-19 viral pneumonia in 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We identified 7,047 patients who received ECMO support for acute respiratory failure related to COVID-19. A total of 32% of patients were recorded as having a tracheostomy procedure during ECMO, and 51% had a tracheostomy at some point during hospitalization. The frequency of tracheostomy was similar in pre-COVID-19 viral pneumonia, but tracheostomies were performed 3 days earlier compared with patients with COVID-19 (median 6.7 d [interquartile range [IQR], 3.0-12.0 d] vs 10.0 d [IQR, 5.0-16.5 d]; p < 0.001). More patients were mobilized with pre-COVID-19 viral pneumonia, but receipt of a tracheostomy during ECMO was associated with increased mobilization in both cohorts. More bleeding complications occurred in patients who received a tracheostomy, with 9% of patients with COVID-19 who received a tracheostomy reported as having surgical site bleeding. CONCLUSIONS: Tracheostomies are performed in COVID-19 patients receiving ECMO at rates similar to practices in pre-COVID-19 viral pneumonia, although later during the course of ECMO. Receipt of a tracheostomy was associated with increased patient mobilization. Overall mortality was similar between those who did and did not receive a tracheostomy. CI - Copyright (c) 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. FAU - Kohne, Joseph G AU - Kohne JG AD - Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI. AD - Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, MI. FAU - MacLaren, Graeme AU - MacLaren G AD - Cardiothoracic Intensive Care Unit, National University Health System, Singapore. FAU - Cagino, Leigh AU - Cagino L AD - Department of Internal Medicine, University of Michigan, Ann Arbor, MI. FAU - Boonstra, Philip S AU - Boonstra PS AD - School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor, MI. FAU - Brodie, Daniel AU - Brodie D AD - Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY. AD - Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY. FAU - Barbaro, Ryan P AU - Barbaro RP AD - Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI. AD - Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, MI. LA - eng GR - R01 HD015434/HD/NICHD NIH HHS/United States GR - R01 HL153519/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20220516 PL - United States TA - Crit Care Med JT - Critical care medicine JID - 0355501 SB - IM MH - *COVID-19/therapy MH - *Extracorporeal Membrane Oxygenation/methods MH - Humans MH - Registries MH - *Respiratory Distress Syndrome MH - *Respiratory Insufficiency MH - Retrospective Studies MH - Tracheostomy/methods PMC - PMC9380152 COIS- Dr. MacLaren disclosed that he serves on the Board of Directors of Extracorporeal Life Support Organization (ELSO). Dr. Brodie's institution received funding from ALung Technologies; he received funding from Baxter, Xenios, Abiomed, Cellenkos, Hemovent, and Medtronic; he disclosed that he is the ongoing President-elect for ELSO. Dr. Barbaro's institution received funding from ARDS in Children and ECMO initiation strategies' impact on Neuro-Development (ASCEND), the National Heart, Lung, and Blood Institute (R01 HL153519), and the National Institute of Child Health and Human Development (R01 HD015434); he disclosed that he is the ELSO Registry Chair; he received support for article research from the National Institutes of Health; he disclosed the off-label product use of extracorporeal membrane oxygenation support. Dr. Boonstra has received funding from ELSO for statistical analysis unrelated to this study. The remaining authors have disclosed that they do not have any potential conflicts of interest. EDAT- 2022/05/25 06:00 MHDA- 2022/08/23 06:00 PMCR- 2022/05/16 CRDT- 2022/05/24 04:33 PHST- 2022/05/25 06:00 [pubmed] PHST- 2022/08/23 06:00 [medline] PHST- 2022/05/24 04:33 [entrez] PHST- 2022/05/16 00:00 [pmc-release] AID - 00003246-202209000-00008 [pii] AID - 10.1097/CCM.0000000000005579 [doi] PST - ppublish SO - Crit Care Med. 2022 Sep 1;50(9):1360-1370. doi: 10.1097/CCM.0000000000005579. Epub 2022 May 16.