Bleeding Hazard of Percutaneous Tracheostomy in COVID-19 Patients Supported With Venovenous Extracorporeal Membrane Oxygenation: A Case Series

Abstract

ObjectivesTracheostomy is usually performed to aid weaning from mechanical ventilation and facilitate rehabilitation and secretion clearance. Little is known about the safety of percutaneous tracheostomy in patients with severe COVID-19 supported on veno-venous extracorporeal membrane oxygenation (VV-ECMO). This study aims to investigate the bleeding risk of bedside percutaneous tracheostomy in patients with COVID-19 infection supported with VV-ECMO.DesignA Retrospective review of electronic data for routine care of patients on ECMO.SettingTertiary, university affiliated national ECMO centre.ParticipantsCOVID-19 patients who underwent percutaneous tracheostomy while on VV-ECMO support.InterventionsNo intervention was conducted during this study. Measurements and Main Results: Electronic medical records of 16 confirmed COVID-19 patients who underwent percutaneous tracheostomy while on VV-ECMO support, including patient demographics, severity of illness, clinical variables, procedural complications, and outcome were compared with 16 non-COVID-19 cases. SPSS statistical software was used for statistical analysis. Demographic data were compared using the chi-square test and normality assumption was test using Shapiro-Wilk test. The indications for tracheostomy in all the cases were prolonged mechanical ventilation and sedation management. None of the patients suffered a life-threatening procedural complication within 48 hours. Moderate to severe bleeding was similar in both groups. There was no difference in 30 and 90-days mortality between both groups. As per routine screening results, none of the staff involved contracted COVID-19 infection.ConclusionsIn this case series percutaneous tracheostomy during VV-ECMO in COVID-19 patients appeared to be safe and did not pose additional risks to patients or healthcare workers.