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.