• Matthieu Schmidt, Christoph Fisser, Gennaro Martucci, Darryl Abrams, Thomas Frapard, Konstantin Popugaev, Antonio Arcadipane, Bianca Bromberger, Giovanni Lino, Alexis Serra, Sacha Rozencwajg, Matthias Lubnow, Sergey Petrikov, Thomas Mueller, Alain Combes, Tài Pham, Daniel Brodie, and International ECMO Network (ECMONet).
• Sorbonne Université, Paris 06, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, 75651, Paris Cedex 13, France. matthieu.schmidt@aphp.fr.
• Crit Care. 2021 Jul 7; 25 (1): 238.

BackgroundCurrent practices regarding tracheostomy in patients treated with extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome are unknown. Our objectives were to assess the prevalence and the association between the timing of tracheostomy (during or after ECMO weaning) and related complications, sedative, and analgesic use.MethodsInternational, multicenter, retrospective study in four large volume ECMO centers during a 9-year period.ResultsOf the 1,168 patients treated with ECMO for severe ARDS (age 48 ± 16 years, 76% male, SAPS II score 51 ± 18) during the enrollment period, 353 (30%) and 177 (15%) underwent tracheostomy placement during or after ECMO, respectively. Severe complications were uncommon in both groups. Local bleeding within 24 h of tracheostomy was four times more frequent during ECMO (25 vs 7% after ECMO, p < 0.01). Cumulative sedative consumption decreased more rapidly after the procedure with sedative doses almost negligible 48-72 h later, when tracheostomy was performed after ECMO decannulation (p < 0.01). A significantly increased level of consciousness was observed within 72 h after tracheostomy in the "after ECMO" group, whereas it was unchanged in the "during-ECMO" group.ConclusionIn contrast to patients undergoing tracheostomy after ECMO decannulation, tracheostomy during ECMO was neither associated with a decrease in sedation and analgesia levels nor with an increase in the level of consciousness. This finding together with a higher risk of local bleeding in the days following the procedure reinforces the need for a case-by-case discussion on the balance between risks and benefits of tracheotomy when performed during ECMO.

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