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.

中文翻译：

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体外膜氧合支持的 COVID-19 患者的气管切开术实践和结果：体外生命支持组织注册分析

目标： 

主要医疗机构支持在 COVID-19 患者中使用体外膜肺氧合 (ECMO)，但 ECMO 期间具体管理策略的作用需要进一步研究。我们试图描述ECMO 支持的与 COVID-19 相关的急性呼吸衰竭患者的气管切开术实践、并发症和结果。

设计： 

回顾性队列研究。

环境： 

ECMO 中心为体外生命支持组织注册表做出贡献。

患者： 

接受静脉 ECMO 呼吸支持的 16 岁或以上患者：1) 2020 年和 2021 年（至 2021 年 10 月）的 COVID-19 和 2) 2019 年 COVID-19 之前的病毒性肺炎。

干预措施： 

没有任何。

测量和主要结果： 

我们确定了 7,047 名因与 COVID-19 相关的急性呼吸衰竭而接受 ECMO 支持的患者。共有 32% 的患者被记录为在 ECMO 期间进行了气管切开术，51% 的患者在住院期间的某个时间点进行了气管切开术。气管切开术的频率在 COVID-19 病毒性肺炎之前相似，但与 COVID-19 患者相比，气管切开术提前 3 天（中位数 6.7 天 [四分位数间距 [IQR]，3.0-12.0 天] vs 10.0 天 [IQR , 5.0–16.5 d]; p < 0.001)。更多患者因 COVID-19 之前的病毒性肺炎而动员起来，但接受了气管切开术ECMO 期间与两个队列的动员增加有关。接受气管切开术的患者发生了更多的出血并发症，9% 接受气管切开术的 COVID-19 患者报告有手术部位出血。

结论： 

在接受 ECMO 治疗的 COVID-19 患者中进行气管切开术的速度与 COVID-19 之前病毒性肺炎的做法相似，尽管是在 ECMO 治疗的后期。接受气管切开术与增加患者的活动能力有关。接受和未接受气管切开术的患者的总体死亡率相似。