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Optimal timing of tracheostomy in patients on veno‐venous extracorporeal membrane oxygenation for coronavirus 2019: a case series

AIM: An early tracheostomy is often considered for patients with veno‐venous extracorporeal membrane oxygenation (VV‐ECMO). However, there is no consensus on the timing of a tracheostomy in patients on VV‐ECMO for coronavirus disease 2019 (COVID‐19). The present report described the optimal timing o...

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Autores principales: Matsuyoshi, Takeo, Shimizu, Keiki, Kaneko, Hitoshi, Kohsen, Daiyu, Suzuki, Hiroaki, Sato, Yuichi, Hamaguchi, Jun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127047/
https://www.ncbi.nlm.nih.gov/pubmed/34026232
http://dx.doi.org/10.1002/ams2.662
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author Matsuyoshi, Takeo
Shimizu, Keiki
Kaneko, Hitoshi
Kohsen, Daiyu
Suzuki, Hiroaki
Sato, Yuichi
Hamaguchi, Jun
author_facet Matsuyoshi, Takeo
Shimizu, Keiki
Kaneko, Hitoshi
Kohsen, Daiyu
Suzuki, Hiroaki
Sato, Yuichi
Hamaguchi, Jun
author_sort Matsuyoshi, Takeo
collection PubMed
description AIM: An early tracheostomy is often considered for patients with veno‐venous extracorporeal membrane oxygenation (VV‐ECMO). However, there is no consensus on the timing of a tracheostomy in patients on VV‐ECMO for coronavirus disease 2019 (COVID‐19). The present report described the optimal timing of tracheostomy for these patients. METHOD: The present study was a single‐center case series. We retrospectively reviewed the medical records of nine consecutive patients who underwent tracheostomy either during or after VV‐ECMO treatment in our center between January 1, 2020 and December 31, 2020. RESULTS: All the patients received a percutaneous dilatational tracheostomy, which was performed during VV‐ECMO in four patients. Three of these patients experienced hemorrhagic complications, and the remaining patient required a circuit change on the day after the operation. Heparin was discontinued 8 h preoperatively and resumed 1–14 h later. The platelet count was below normal in two patients, but no transfusion was performed. APTT was almost normal, and D‐dimer was elevated postoperatively. The remaining five patients received a tracheostomy after weaning off VV‐ECMO, and no complication was observed. Eight patients were deeply sedated during VV‐ECMO to prioritize lung rest and prevent infecting the healthcare workers. CONCLUSION: In the present study, patients who underwent a tracheostomy during VV‐ECMO tended to have more hemorrhagic complications. Because an early tracheostomy during ECMO has little benefit for patients with COVID‐19, it should be performed after weaning off VV‐ECMO to protect the safety of the healthcare workers concerned.
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spelling pubmed-81270472021-05-21 Optimal timing of tracheostomy in patients on veno‐venous extracorporeal membrane oxygenation for coronavirus 2019: a case series Matsuyoshi, Takeo Shimizu, Keiki Kaneko, Hitoshi Kohsen, Daiyu Suzuki, Hiroaki Sato, Yuichi Hamaguchi, Jun Acute Med Surg Brief Communications AIM: An early tracheostomy is often considered for patients with veno‐venous extracorporeal membrane oxygenation (VV‐ECMO). However, there is no consensus on the timing of a tracheostomy in patients on VV‐ECMO for coronavirus disease 2019 (COVID‐19). The present report described the optimal timing of tracheostomy for these patients. METHOD: The present study was a single‐center case series. We retrospectively reviewed the medical records of nine consecutive patients who underwent tracheostomy either during or after VV‐ECMO treatment in our center between January 1, 2020 and December 31, 2020. RESULTS: All the patients received a percutaneous dilatational tracheostomy, which was performed during VV‐ECMO in four patients. Three of these patients experienced hemorrhagic complications, and the remaining patient required a circuit change on the day after the operation. Heparin was discontinued 8 h preoperatively and resumed 1–14 h later. The platelet count was below normal in two patients, but no transfusion was performed. APTT was almost normal, and D‐dimer was elevated postoperatively. The remaining five patients received a tracheostomy after weaning off VV‐ECMO, and no complication was observed. Eight patients were deeply sedated during VV‐ECMO to prioritize lung rest and prevent infecting the healthcare workers. CONCLUSION: In the present study, patients who underwent a tracheostomy during VV‐ECMO tended to have more hemorrhagic complications. Because an early tracheostomy during ECMO has little benefit for patients with COVID‐19, it should be performed after weaning off VV‐ECMO to protect the safety of the healthcare workers concerned. John Wiley and Sons Inc. 2021-05-17 /pmc/articles/PMC8127047/ /pubmed/34026232 http://dx.doi.org/10.1002/ams2.662 Text en © 2021 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Brief Communications
Matsuyoshi, Takeo
Shimizu, Keiki
Kaneko, Hitoshi
Kohsen, Daiyu
Suzuki, Hiroaki
Sato, Yuichi
Hamaguchi, Jun
Optimal timing of tracheostomy in patients on veno‐venous extracorporeal membrane oxygenation for coronavirus 2019: a case series
title Optimal timing of tracheostomy in patients on veno‐venous extracorporeal membrane oxygenation for coronavirus 2019: a case series
title_full Optimal timing of tracheostomy in patients on veno‐venous extracorporeal membrane oxygenation for coronavirus 2019: a case series
title_fullStr Optimal timing of tracheostomy in patients on veno‐venous extracorporeal membrane oxygenation for coronavirus 2019: a case series
title_full_unstemmed Optimal timing of tracheostomy in patients on veno‐venous extracorporeal membrane oxygenation for coronavirus 2019: a case series
title_short Optimal timing of tracheostomy in patients on veno‐venous extracorporeal membrane oxygenation for coronavirus 2019: a case series
title_sort optimal timing of tracheostomy in patients on veno‐venous extracorporeal membrane oxygenation for coronavirus 2019: a case series
topic Brief Communications
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127047/
https://www.ncbi.nlm.nih.gov/pubmed/34026232
http://dx.doi.org/10.1002/ams2.662
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