# Outcomes for COVID-19 Patients Undergoing Tracheostomy With or Without Extracorporeal Membrane Oxygenation (ECMO)

## TL;DR

This study found that patients with severe COVID-19 who had ECMO before tracheostomy had worse outcomes, including higher mortality and more complications.

## Contribution

The study provides new insights into the impact of ECMO cannulation timing on tracheostomy outcomes in severe COVID-19 patients.

## Key findings

- Patients on ECMO had longer time from admission to intubation and more intubations.
- ECMO patients had higher rates of postoperative bleeding and mortality.
- ECMO cannulation before tracheostomy was associated with poorer outcomes.

## Abstract

Introduction

The coronavirus disease 2019 (COVID-19) pandemic led to the more common use of venovenous (VV) extracorporeal membrane oxygenation (ECMO) for adults with acute respiratory distress syndrome (ARDS). While tracheostomy is generally understood to decrease the risks of prolonged endotracheal intubation, there is conflicting data regarding the benefit of tracheostomy in patients on ECMO. The purpose of this study is to determine whether ECMO cannulation before tracheostomy impacted patient outcomes.

Methods

This is a retrospective chart review of patients who underwent tracheostomy for COVID-19-related ARDS at a tertiary academic center from March 2020 through March 2022. Patients were separated into two groups based on whether they were cannulated for ECMO prior to tracheostomy. Fisher’s exact test or Wilcoxon rank sum test was used to compare the two groups.

Results

A total of 24 patients were included in the study, with 13 in the ECMO group and 11 in the non-ECMO group. There was no significant difference in age, comorbidities, race, or gender between the groups. Patients on ECMO had a longer time from admission to intubation (seven days vs. three days, p=.002), were more likely to have multiple intubations (54% vs 9%, p= .033), had increased rates of postoperative bleeding (62% vs. 18%, p = .047), and had a higher mortality rate (39% vs. 0%, p= .041).

Conclusions

ECMO cannulation prior to tracheostomy for COVID-19-related ARDS is associated with poorer outcomes. It is unclear whether this is related to a more severe disease burden in these patients. Further study is needed to evaluate this and guide future management.