Percutaneous dilatational tracheostomy in patients with mechanical circulatory support: Is the procedure safe?

Background: We aimed to investigate the efficacy and safety of percutaneous dilatational tracheostomy procedure following cardiac surgery in patients receiving extracorporeal membrane oxygenation and/or left ventricular assist device. Methods: A total of 42 patients (10 males, 32 females; mean age 51 +/- 14.6 years; range, 18 to 77 years) who underwent percutaneous dilatational tracheostomy procedure under extracorporeal membrane oxygenation and/or left ventricular assist device support between January 2017 and January 2019 were retrospectively analyzed. Laboratory data, Simplified Acute Physiology Score-II and Sequential Organ Failure Assessment scores, and major and minor complications were recorded. The 30-day and one-year follow-up outcomes of the patients were reviewed. Results: Of 42 patients, 17 (42.5%), 14 (33.3%), and 11 (26.2%) received left ventricular assist device, extracorporeal membrane oxygenation, and extracorporeal membrane oxygenation + left ventricular assist device, respectively. During percutaneous dilatational tracheostomy, the laboratory values of the patients were as follows: international normalized ratio, 2.3 +/- 0.9; partial thromboplastin time, 59.4 +/- 19.5 sec; platelet count, 139.2 +/- 65.8x10(9)/L, hemoglobin, 8.8 +/- 1.0 g/dL, and creatinine, 1.6 +/- 1.0 mg/dL. No peri-procedural mortality, major complication, or bleeding was observed. We observed minor complications including localized stomal ooze in four patients (8.3%) and local stomal infection in three patients (6.2%). Conclusion: Our study results suggest that percutaneous dilatational tracheostomy is an effective and safe technique in this patient population.