ECMO Course-
After one week of ECMO support patients were evaluated regarding their potential need for tracheostomy placement based on their clinical progress. Patients whose lung function showed little improvement or who displayed significant agitation or ventilator dysynchrony during sedation holidays were considered for tracheostomy placement. A tracheostomy was performed in 6 of the Covid-19 ECMO patients. Anticoagulation was continued and the tracheostomy was placed utilizing a percutaneous approach with electrocautery to minimize bleeding. The number of providers in the room was again limited to the ECMO physician/intensivist, bedside RN, cardiac surgeon, and an operating room assistant. During placement of the tracheostomy, the ventilator was placed in standby mode. Two patients had minor bleeding which was controlled through electrocautery without interruption of anticoagulation.