Dwight D Harris1, Alexis E Shafii2, Maher Baz2, Thomas A Tribble3, Victor A Ferraris2. 1. 1 College of Medicine, University of Kentucky, Lexington, KY, USA. 2. 2 Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, KY, USA. 3. 3 Gill Heart Institute, University of Kentucky Gill Heart Institute, University of Kentucky, Lexington, KY, USA.
Abstract
INTRODUCTION: Tracheostomy has been utilized in combination with venovenous extracorporeal membrane oxygenation (VV-ECMO) to enable early spontaneous breathing and minimize sedation requirements. Tracheostomy has been previously reported to be safe in patients supported on VV-ECMO; however, the impact of tracheostomy on blood loss in VV-ECMO patients is unknown. METHODS: We analyzed VV-ECMO patients with and without tracheostomy over a 5-year period. In order to avoid other potential sources of blood loss not related to tracheostomy or ECMO-related blood loss, patients who underwent a recent surgery prior to ECMO or during ECMO (other than tracheostomy) were excluded. RESULTS: Sixty-three patients meeting the inclusion criteria were identified (tracheostomy n=30, non-tracheostomy n=33). Tracheostomy patients were found to require more daily transfusions of red blood cells (RBC) (0.47 [0.20-1.0] vs. 0.23 [0.06-0.40] units/day, p=0.02) and total blood products (0.60 [0.32-1.0] vs. 0.31 [0.10-0.50] units/day, p=0.01). CONCLUSIONS: These results suggest that tracheostomy while on VV-ECMO predisposes patients to increased transfusion burden. Based on previous research, this increased transfusion burden could potentially be linked to increased complications and mortality.
INTRODUCTION: Tracheostomy has been utilized in combination with venovenous extracorporeal membrane oxygenation (VV-ECMO) to enable early spontaneous breathing and minimize sedation requirements. Tracheostomy has been previously reported to be safe in patients supported on VV-ECMO; however, the impact of tracheostomy on blood loss in VV-ECMO patients is unknown. METHODS: We analyzed VV-ECMO patients with and without tracheostomy over a 5-year period. In order to avoid other potential sources of blood loss not related to tracheostomy or ECMO-related blood loss, patients who underwent a recent surgery prior to ECMO or during ECMO (other than tracheostomy) were excluded. RESULTS: Sixty-three patients meeting the inclusion criteria were identified (tracheostomy n=30, non-tracheostomy n=33). Tracheostomy patients were found to require more daily transfusions of red blood cells (RBC) (0.47 [0.20-1.0] vs. 0.23 [0.06-0.40] units/day, p=0.02) and total blood products (0.60 [0.32-1.0] vs. 0.31 [0.10-0.50] units/day, p=0.01). CONCLUSIONS: These results suggest that tracheostomy while on VV-ECMO predisposes patients to increased transfusion burden. Based on previous research, this increased transfusion burden could potentially be linked to increased complications and mortality.
Authors: Ismael A Salas De Armas; Kha Dinh; Bindu Akkanti; Pushan Jani; Reshma Hussain; Lisa Janowiak; Kayla Kutilek; Manish K Patel; Mehmet H Akay; Rahat Hussain; Jayeshkumar Patel; Chandni Patel; Yafen Liang; John Zaki; Biswajit Kar; Igor D Gregoric Journal: J Extra Corpor Technol Date: 2020-12
Authors: Joseph G Kohne; Graeme MacLaren; Erica Rider; Benjamin D Carr; Palen Mallory; Acham Gebremariam; Matthew L Friedman; Ryan P Barbaro Journal: Pediatr Crit Care Med Date: 2022-01-26 Impact factor: 3.971