Intensive Care Medicine

, Volume 39, Issue 10, pp 1792–1799 | Cite as

Safety of percutaneous dilatational tracheostomy in patients on extracorporeal lung support

  • Stephan Braune
  • Susanne Kienast
  • Johannes Hadem
  • Olaf Wiesner
  • Dominic Wichmann
  • Axel Nierhaus
  • Marcel Simon
  • Tobias Welte
  • Stefan Kluge
Original Article

Abstract

Purpose

To evaluate the safety of percutaneous dilatational tracheostomy (PDT) in critically ill patients on an extracorporeal lung assist device requiring therapeutic anticoagulation.

Methods

This was a retrospective, observational study on all patients undergoing tracheostomy while on pumpless extracorporeal lung assist or extracorporeal membrane oxygenation in intensive care units of two university hospitals in Germany between 2007 and 2013.

Results

During the study period PDT was performed on 118 patients. The median platelet count, international normalized ratio, and activated partial thromboplastin time before tracheostomy were 126 × 109/L (range 16–617 × 109/L), 1.1 (0.9–2.0) and 49 s (28–117 s), respectively. Seventeen patients (14.4 %) received a maximum of three bags of pooled platelets, and eight patients (6.8 %) received a maximum of four units of fresh frozen plasma before the procedure. In all patients the administration of intravenous heparin was briefly paused periprocedurally. No periprocedural clotting complication within the extracorporeal circuit was observed. Two patients (1.7 %) suffered from procedure-related major bleeding, with one patient requiring conversion to a surgical tracheostomy. Two pneumothoraces (1.7 %) were related to the PDT. One patient (0.8 %) had analgosedation-related hypotension with brief and successful cardiopulmonary resuscitation. Minor bleeding from the tracheostomy site occurred in 37 cases (31.4 %). No fatality was attributable to tracheostomy.

Conclusions

The complication rates of PDT in the patients on extracorporeal lung support were low and comparable to those of other critically ill patients. Based on these results, we conclude that PDT performed by experienced operators with careful optimization of the coagulation state is a relatively safe procedure and not contraindicated for this patient group.

Keywords

Percutaneous tracheostomy Safety Extracorporeal lung support Respiratory weaning ECMO ECLA 

Notes

Conflicts of interest

SB and AN have received lecture honoraria from Novalung GmbH, Talheim, Germany. SK is a member of the advisory board of Novalung GmbH and therefore has received advisor honoraria. All other authors declare that they have no conflicts of interest.

Supplementary material

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Supplementary material 1 (DOCX 14 kb)
134_2013_3023_MOESM2_ESM.docx (15 kb)
Supplementary material 2 (DOCX 15 kb)
134_2013_3023_MOESM3_ESM.docx (15 kb)
Supplementary material 3 (DOCX 14 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Stephan Braune
    • 1
  • Susanne Kienast
    • 1
  • Johannes Hadem
    • 2
  • Olaf Wiesner
    • 3
  • Dominic Wichmann
    • 1
  • Axel Nierhaus
    • 1
  • Marcel Simon
    • 1
  • Tobias Welte
    • 3
  • Stefan Kluge
    • 1
  1. 1.Department of Intensive Care MedicineUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Department of Gastroenterology, Hepatology and EndocrinologyHannover Medical SchoolHannoverGermany
  3. 3.Department of Respiratory MedicineHannover Medical SchoolHannoverGermany

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