Influence and complications of tracheotomy on V-V ECMO: a 10-year analysis

Aim: Tracheotomy (surgical sTT, percutaneous pTT) is considered in long-term mechanical ventilation. Little is known on the influence and complications of TT on V-V ECMO. Methods: We analyzed 619 patients on V-V ECMO (2008-2017). TT was done on or after ECMO. Complications, ventilatory and ECMO settings were analyzed on and for two days after TT. Major bleeding was defined as drop of hemoglobin of ≥2g/dl/day and/or transfusion of 2≥RBC/day. Acute hypoxia or hypotension (drop of SpO2 of ≤85%, or BPsys ≤85mmHg within 30 minutes after TT), and pneumothorax were recorded. Sedation was assessed by RASS and dosing of sedating drugs. Results: TT on ECMO was done in 25% (14% dTT, 11% sTT) and in 14% after ECMO. Major/minor bleeding were higher on than after ECMO, while other complications were not different (Table 1a. In multivariate analysis TT on ECMO was attributed only to major bleeding (Table 1b). Between sTT and pTT, complications were similar (not shown). After TT, RASS and sedating drugs were decreased. PEEP and MPaw were reduced. While ECMO and sweep flow were reduced after TT, minute ventilation, tidal volume and respiratory rate increased (Table 2). Summary: Bleeding in tracheotomy was more common on than after ECMO while other complications were not. Complication rate was similar between sTT and pTT. TT resulted in lower sedation. Mean airway pressure, PEEP, ECMO and sweep flow were reduced while minute ventilation increased.