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• W4387249093 abstract "SESSION TITLE: Critical Care Posters 11 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm PURPOSE: During the on-going COVID-19 pandemic, the use of extracorporeal membrane oxygenation (ECMO) for rescue therapy in those with acute respiratory distress syndrome (ARDs) increased. Most patients required prolonged mechanical ventilation and ECMO cannulation times, resulting in the need for tracheostomy placement. We studied our patient population to assess if early vs late tracheostomy placement was associated with shorter duration of ECMO. METHODS: We conducted a single center retrospective chart review of patients with and without COVID-19 who were supported by ECMO and underwent tracheostomy during their admission to the University of Arizona Medical Center, Phoenix between December 2019 to Febuary 2023. Our primary objective was duration on ECMO circuit in those with early (defined as less than 14 days from ECMO cannulation) vs late (defined as those greater than 14 days from ECMO cannulation) tracheostomy placement. Statistical analysis was performed with Wilcoxon rank-sum test for continuous variables and Fisher's exact test or Chi-squared test for the remaining categorical variables. RESULTS: 93 patients were reviewed and 73 included in the final analysis. Three subgroups were analyzed. Group 1, all patients on ECMO, group 2, those with a diagnosis of COVID-19 on ECMO and group 3, those without COVID-19 on ECMO. Group 1 included a total of 73 subjects, 31 who underwent early tracheostomy vs 42 who received late tracheostomy. Group 2 included 45 subjects, 17 who underwent early tracheostomy vs 28 who received late tracheostomy, and group 3 included a total of 28 subjects on ECMO with 14 receiving early tracheostomy and 14 received late tracheostomy. In those with COVID 19 (group 2) subjects were found to be on ECMO for 58 days with an interquartile range (IQR) 38,93, vs those who received late tracheostomy who were on ECMO for 39 days (IQR 25, 44.5), p-value 0.014. Length of hospital stay for the COVID-19 early tracheostomy group was 102 days (IQR 68, 121) compared to those with late tracheostomy, 62.5 days (IQR 40, 76), p-value 0.01. In group 3, median days on ECMO was 16.5 (IQR 12.2, 33.5) in the early tracheostomy group. In the late group, duration of ECMO was 30 days (IQR 14.5, 45). P-value 0.29. CONCLUSIONS: Our retrospective review of subjects who received ECMO for ARDs in those with or without COVID-19 revealed that placement of early tracheostomy resulted in prolonged ECMO duration, increased ICU LOS, and increased hospital LOS. Although not statistically significant there was also a trend towards increased mortality in those who underwent early tracheostomy in the COVID-19 group. CLINICAL IMPLICATIONS: Studies suggest early tracheostomy for patients intubated with ARDs shows benefit with regards to ICU length of stay, decreased ventilator associated pneumonia and overall morbidity. We showcase one of the first detailed review of patients with COVID-19 on ECMO suggesting that early tracheostomy leads to poorer outcomes including prolonged ECMO duration and increased overall LOS. DISCLOSURES: No relevant relationships by Christopher Dossett No relevant relationships by Zachary Hernandez No relevant relationships by Chengcheng Hu No relevant relationships by Autumn Lemke No relevant relationships by Francisco Marquez No relevant relationships by Daniel Rabulinski No relevant relationships by Esa Rayyan No relevant relationships by Nafis Shamsid-Deen No relevant relationships by Sally Suliman No relevant relationships by Daniel Yu" @default.
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• W4387249093 date "2023-10-01" @default.
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• W4387249093 title "EARLY VS LATE TRACHEOSTOMY IN PATIENTS REQUIRING EXTRACORPOREAL OXYGEN (ECMO) FOR ARDS IN THOSE WITH AND WITHOUT COVID-19 INFECTION" @default.
• W4387249093 doi "https://doi.org/10.1016/j.chest.2023.07.1208" @default.
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