Early Tracheostomy May Be Performed Safely in Obese COVID-19 Patients Supported on VV-ECMO

Abstract

Objective: Obese patients with coronavirus disease 2019 (COVID-19)–associated acute respiratory failure (ARDS) often require prolonged intubation. However, data are sparse regarding optimal tracheostomy timing in obese adults with COVID-19 requiring venovenous extracorporeal membrane oxygenation (VV-ECMO). This study retrospectively describes the course of obese patients with COVID-19 who underwent tracheostomy on VV-ECMO between March 2020 and December 2022. Methods: There were 62 participants with a median age of 43 (interquartile range [IQR] 33 to 53) years and a median body mass index of 42 (IQR 34 to 50) kg/m2 who received VV-ECMO for COVID-19–associated ARDS. Of those, 42 underwent tracheostomy on VV-ECMO, and 50% ( n = 21) of the 42 patients underwent early (within 14 days of initiated ventilatory support) tracheostomy. Results: Among patients who received tracheostomies, the combined respiratory tract and lung parenchymal bleeding rate was 29% ( n = 12), but only 7% required surgical intervention for bleeding from the tracheostomy site ( n = 3). The hospital length of stay (LOS) was 42 (IQR 36 to 57) days, and mortality rate was 38% ( n = 16). Tracheostomy timing was not associated with differences in respiratory tract bleeding, mechanical ventilatory support duration, VV-ECMO support duration, intensive care unit LOS, hospital LOS, mortality, or survival probability. Conclusions: Although an individualized and holistic approach to clinical decision making continues to be necessary, the findings of this study suggest that early tracheostomy may be performed safely in obese patients with COVID-19 on VV-ECMO.