Safety of Surgical Tracheostomy during Extracorporeal Membrane Oxygenation
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background: The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO. Methods: From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST. Results: Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×109/L (range, 46 to 434 ×109/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST. Conclusions: The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.
Abstract
Background: The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO. Methods: From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST. Results: Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×109/L (range, 46 to 434 ×109/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST. Conclusions: The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.
참고문헌 (26)
- Camporota L, "International survey on the management of mechanical ventilation during ECMO in adults with severe respiratory failure", Minerva Anestesiol, 81, pp.1170~1183 (2015)
- Langer T, "“Awake” extracorporeal membrane oxygenation (ECMO): pathophysiology, technical considerations, and clinical pioneering", Crit Care, 20, pp.150~ (2016)
- Schmidt M, "Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome: a retrospective international multicenter study", Crit Care Med, 43, pp.654~664 (2015)
- Keeping A., "Early versus late tracheostomy for critically ill patients: a clinical evidence synopsis of a recent Cochrane Review", Can J Respir Ther, 52, pp.27~28 (2016)
- "Extracorporeal Life Support Organization (ELSO) general guidelines for all ECLS cases" (2013)[URL]
- Schoenfeld DA, "Statistical evaluation of ventilator-free days as an efficacy measure in clinical trials of treatments for acute respiratory distress syndrome", Crit Care Med, 30, pp.1772~1777 (2002)
- Hayes D Jr, "Tracheostomy in adolescent patients bridged to lung transplantation with ambulatory venovenous extracorporeal membrane oxygenation", J Artif Organs, 17, pp.103~105 (2014)
- Turković TM, "The impact of tracheotomy on the clinical course of ventilator-associated pneumonia", Acta Clin Croat, 55, pp.100~109 (2016)
- Braune S, "Safety of percutaneous dilatational tracheostomy in patients on extracorporeal lung support", Intensive Care Med, 39, pp.1792~1799 (2013)
- Malfertheiner MV, "Hemostatic changes during extracorporeal membrane oxygenation: a prospective randomized clinical trial comparing three different extracorporeal membrane oxygenation systems", Crit Care Med, 44, pp.747~754 (2016)
- Shah RK, "Tracheotomy outcomes and complications: a national perspective", Laryngoscope, 122, pp.25~29 (2012)
- Goldenberg D, "Tracheotomy complications: a retrospective study of 1130 cases", Otolaryngol Head Neck Surg, 123, pp.495~500 (2000)
- Costa L, "Urgent tracheostomy: four-year experience in a tertiary hospital", World J Emerg Med, 7, pp.227~230 (2016)
- Pasin L, "Percutaneous tracheostomy in patients on anticoagulants", Ann Card Anaesth, 18, pp.329~334 (2015)
- Yeo HJ, "Low-dose heparin during extracorporeal membrane oxygenation treatment in adults", Intensive Care Med, 41, pp.2020~2021 (2015)
- Freeman BD, "A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients", Chest, 118, pp.1412~1418 (2000)
- Delaney A, "Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta-analysis", Crit Care, 10, pp.R55~ (2006)
- Hashemian SM, "A prospective randomized study comparing mini-surgical percutaneous dilatational tracheostomy with surgical and classical percutaneous tracheostomy: a new method beyond contraindications", Medicine (Baltimore), 94, pp.e2015~ (2015)
- Johnson-Obaseki S, "Complication rates of open surgical versus percutaneous tracheostomy in critically ill patients", Laryngoscope, 126, pp.2459~2467 (2016)
- Lother A, "Fatal air embolism as complication of percutaneous dilatational tracheostomy on venovenous extracorporeal membrane oxygenation, two case reports", J Cardiothorac Surg, 11, pp.102~ (2016)
- Klancir T, "Bilateral pneumothorax as a complication of percutaneous tracheostomy: case report", Acta Clin Croat, 55(Suppl 1), pp.98~102 (2016)
- Huang CS, "Relative contraindications for percutaneous tracheostomy: from the surgeons’ perspective", Surg Today, 44, pp.107~114 (2014)
- Lin JC, "Extensive posterior-lateral tracheal laceration complicating percutaneous dilational tracheostomy", Ann Thorac Surg, 70, pp.1194~1196 (2000)
- Brass P, "Percutaneous techniques versus surgical techniques for tracheostomy", Cochrane Database Syst Rev, 7, pp.CD008045~ (2016)
- Redwan B, "Intraoperative venovenous extracorporeal lung support in thoracic surgery:a single-centre experience", Interact Cardiovasc Thorac Surg, 21, pp.766~772 (2015)
- Rinieri P, "National review of use of extracorporeal membrane oxygenation as respiratory support in thoracic surgery excluding lung transplantation", Eur J Cardiothorac Surg, 47, pp.87~94 (2015)