{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:12:02Z","timestamp":1792098722763,"version":"4.4.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T00:00:00Z","timestamp":1625616000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T00:00:00Z","timestamp":1625616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Current practices regarding tracheostomy in patients treated with extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome are unknown. Our objectives were to assess the prevalence and the association between the timing of tracheostomy (during or after ECMO weaning) and related complications, sedative, and analgesic use.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>International, multicenter, retrospective study in four large volume ECMO centers during a 9-year period.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of the 1,168 patients treated with ECMO for severe ARDS (age 48\u2009\u00b1\u200916\u00a0years, 76% male, SAPS II score 51\u2009\u00b1\u200918) during the enrollment period, 353 (30%) and 177 (15%) underwent tracheostomy placement during or after ECMO, respectively. Severe complications were uncommon in both groups. Local bleeding within 24\u00a0h of tracheostomy was four times more frequent during ECMO (25 vs 7% after ECMO, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Cumulative sedative consumption decreased more rapidly after the procedure with sedative doses almost negligible 48\u201372\u00a0h later, when tracheostomy was performed after ECMO decannulation (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). A significantly increased level of consciousness was observed within 72\u00a0h after tracheostomy in the \u201cafter ECMO\u201d group, whereas it was unchanged in the \u201cduring-ECMO\u201d group.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>In contrast to patients undergoing tracheostomy after ECMO decannulation, tracheostomy during ECMO was neither associated with a decrease in sedation and analgesia levels nor with an increase in the level of consciousness. This finding together with a higher risk of local bleeding in the days following the procedure reinforces the need for a case-by-case discussion on the balance between risks and benefits of tracheotomy when performed during ECMO.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13054-021-03649-8","type":"journal-article","created":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T12:03:01Z","timestamp":1625659381000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Tracheostomy management in patients with severe acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: an International Multicenter Retrospective Study"],"prefix":"10.1186","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2931-4412","authenticated-orcid":false,"given":"Matthieu","family":"Schmidt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Fisser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gennaro","family":"Martucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darryl","family":"Abrams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Frapard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantin","family":"Popugaev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Arcadipane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Bromberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Lino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Serra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sacha","family":"Rozencwajg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Lubnow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergey","family":"Petrikov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Mueller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Combes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T\u00e0i","family":"Pham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Brodie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the International ECMO Network (ECMONet)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,7,7]]},"reference":[{"key":"3649_CR1","doi-asserted-by":"publisher","first-page":"1965","DOI":"10.1056\/NEJMoa1800385","volume":"378","author":"A Combes","year":"2018","unstructured":"Combes A, Hajage D, Capellier G, Demoule A, Lavou\u00e9 S, Guervilly C, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378:1965\u201375.","journal-title":"N Engl J Med"},{"key":"3649_CR2","doi-asserted-by":"publisher","first-page":"2251","DOI":"10.1001\/jama.2018.14276","volume":"320","author":"EC Goligher","year":"2018","unstructured":"Goligher EC, Tomlinson G, Hajage D, Wijeysundera DN, Fan E, J\u00fcni P, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome and posterior probability of mortality benefit in a post hoc bayesian analysis of a randomized clinical trial. JAMA. 2018;320:2251\u20139.","journal-title":"JAMA"},{"key":"3649_CR3","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/S2213-2600(18)30452-1","volume":"7","author":"L Munshi","year":"2019","unstructured":"Munshi L, Walkey A, Goligher E, Pham T, Uleryk EM, Fan E. Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis. Lancet Respir Med. 2019;7:163\u201372.","journal-title":"Lancet Respir Med"},{"key":"3649_CR4","doi-asserted-by":"publisher","first-page":"2048","DOI":"10.1007\/s00134-020-06248-3","volume":"46","author":"A Combes","year":"2020","unstructured":"Combes A, Peek GJ, Hajage D, Hardy P, Abrams D, Schmidt M, et al. ECMO for severe ARDS: systematic review and individual patient data meta-analysis. Intensive Care Med. 2020;46:2048\u201357.","journal-title":"Intensive Care Med"},{"key":"3649_CR5","doi-asserted-by":"publisher","first-page":"1505","DOI":"10.1097\/CCM.0000000000003894","volume":"47","author":"S Rozencwajg","year":"2019","unstructured":"Rozencwajg S, Guihot A, Franchineau G, Lescroat M, Br\u00e9chot N, H\u00e9kimian G, et al. Ultra-protective ventilation reduces biotrauma in patients on venovenous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. Crit Care Med. 2019;47:1505\u201312.","journal-title":"Crit Care Med"},{"key":"3649_CR6","doi-asserted-by":"publisher","first-page":"1002","DOI":"10.1164\/rccm.201806-1094OC","volume":"200","author":"M Schmidt","year":"2019","unstructured":"Schmidt M, Pham T, Arcadipane A, Agerstrand C, Ohshimo S, Pellegrino V, et al. Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome. An International Multicenter Prospective Cohort. Am J Respir Crit Care Med. 2019;200:1002\u201312.","journal-title":"Am J Respir Crit Care Med"},{"key":"3649_CR7","doi-asserted-by":"publisher","first-page":"1704","DOI":"10.1007\/s00134-013-3037-2","volume":"39","author":"M Schmidt","year":"2013","unstructured":"Schmidt M, Zogheib E, Roze H, Repesse X, Lebreton G, Luyt CE, et al. The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. Intensive Care Med. 2013;39:1704\u201313.","journal-title":"Intensive Care Med"},{"key":"3649_CR8","doi-asserted-by":"publisher","first-page":"373","DOI":"10.7326\/0003-4819-154-6-201103150-00002","volume":"154","author":"J-L Trouillet","year":"2011","unstructured":"Trouillet J-L, Luyt C-E, Guiguet M, Ouattara A, Vaissier E, Makri R, et al. Early percutaneous tracheotomy versus prolonged intubation of mechanically ventilated patients after cardiac surgery: a randomized trial. Ann Intern Med. 2011;154:373\u201383.","journal-title":"Ann Intern Med"},{"key":"3649_CR9","doi-asserted-by":"publisher","first-page":"2121","DOI":"10.1001\/jama.2013.5154","volume":"309","author":"D Young","year":"2013","unstructured":"Young D, Harrison DA, Cuthbertson BH, Rowan K, TracMan Collaborators. Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA. 2013;309:2121\u20139.","journal-title":"JAMA"},{"key":"3649_CR10","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1164\/ajrccm.159.2.9707046","volume":"159","author":"JL Diehl","year":"1999","unstructured":"Diehl JL, El Atrous S, Touchard D, Lemaire F, Brochard L. Changes in the work of breathing induced by tracheotomy in ventilator-dependent patients. Am J Respir Crit Care Med. 1999;159:383\u20138.","journal-title":"Am J Respir Crit Care Med"},{"key":"3649_CR11","doi-asserted-by":"publisher","first-page":"2527","DOI":"10.1097\/01.CCM.0000186898.58709.AA","volume":"33","author":"A Nieszkowska","year":"2005","unstructured":"Nieszkowska A, Combes A, Luyt C-E, Ksibi H, Trouillet J-L, Gibert C, et al. Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Crit Care Med. 2005;33:2527\u201333.","journal-title":"Crit Care Med"},{"key":"3649_CR12","doi-asserted-by":"crossref","unstructured":"Grewal J, Sutt A-L, Cornmell G, Shekar K, Fraser J. Safety and putative benefits of tracheostomy tube placement in patients on extracorporeal membrane oxygenation: a single-center experience. J Intensive Care Med. 2019;885066619837939.","DOI":"10.1177\/0885066619837939"},{"key":"3649_CR13","doi-asserted-by":"publisher","first-page":"1162","DOI":"10.1053\/j.jvca.2017.08.010","volume":"32","author":"N Kruit","year":"2018","unstructured":"Kruit N, Valchanov K, Blaudszun G, Fowles J-A, Vuylsteke A. Bleeding complications associated with percutaneous tracheostomy insertion in patients supported with venovenous extracorporeal membrane oxygen support: a 10-year institutional experience. J Cardiothorac Vasc Anesth. 2018;32:1162\u20136.","journal-title":"J Cardiothorac Vasc Anesth"},{"issue":"66","key":"3649_CR14","first-page":"652","volume":"2020","author":"M Salna","year":"1992","unstructured":"Salna M, Tipograf Y, Liou P, Chicotka S, Biscotti M, Agerstrand C, et al. Tracheostomy is safe during extracorporeal membrane oxygenation support. ASAIO J Am Soc Artif Intern Organs. 1992;2020(66):652\u20136.","journal-title":"ASAIO J Am Soc Artif Intern Organs"},{"key":"3649_CR15","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1164\/rccm.201409-1634OC","volume":"191","author":"RP Barbaro","year":"2015","unstructured":"Barbaro RP, Odetola FO, Kidwell KM, Paden ML, Bartlett RH, Davis MM, et al. Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry. Am J Respir Crit Care Med. 2015;191:894\u2013901.","journal-title":"Am J Respir Crit Care Med"},{"key":"3649_CR16","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1111\/j.1538-7836.2009.03678.x","volume":"8","author":"S Schulman","year":"2010","unstructured":"Schulman S, Anger\u00e5s U, Bergqvist D, Eriksson B, Lassen MR, Fisher W, et al. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients. J Thromb Haemost JTH. 2010;8:202\u20134.","journal-title":"J Thromb Haemost JTH"},{"key":"3649_CR17","unstructured":"STROBE Statement: Home [Internet]. [cited 2020 Aug 21]. Available from: https:\/\/www.strobe-statement.org\/index.php?id=strobe-home"},{"key":"3649_CR18","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1001\/jama.2016.0291","volume":"315","author":"G Bellani","year":"2016","unstructured":"Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315:788\u2013800.","journal-title":"JAMA"},{"key":"3649_CR19","unstructured":"COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med. 2020."},{"key":"3649_CR20","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1186\/s13054-018-2126-6","volume":"22","author":"T Abe","year":"2018","unstructured":"Abe T, Madotto F, Pham T, Nagata I, Uchida M, Tamiya N, et al. Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries. Crit Care Lond Engl. 2018;22:195.","journal-title":"Crit Care Lond Engl"},{"key":"3649_CR21","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1164\/rccm.201502-0239OC","volume":"192","author":"AB Mehta","year":"2015","unstructured":"Mehta AB, Syeda SN, Bajpayee L, Cooke CR, Walkey AJ, Wiener RS. Trends in tracheostomy for mechanically ventilated patients in the United States, 1993\u20132012. Am J Respir Crit Care Med. 2015;192:446\u201354.","journal-title":"Am J Respir Crit Care Med"},{"key":"3649_CR22","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1111\/crj.12286","volume":"10","author":"L Meng","year":"2016","unstructured":"Meng L, Wang C, Li J, Zhang J. Early vs late tracheostomy in critically ill patients: a systematic review and meta-analysis. Clin Respir J. 2016;10:684\u201392.","journal-title":"Clin Respir J"},{"key":"3649_CR23","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1001\/jamaoto.2021.0025","volume":"147","author":"K Chorath","year":"2021","unstructured":"Chorath K, Hoang A, Rajasekaran K, Moreira A. Association of early vs late tracheostomy placement with pneumonia and ventilator days in critically ill patients: a meta-analysis. JAMA Otolaryngol Head Neck Surg. 2021;147:450\u20139.","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"3649_CR24","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1001\/jama.2019.9302","volume":"322","author":"D Brodie","year":"2019","unstructured":"Brodie D, Slutsky AS, Combes A. Extracorporeal life support for adults with respiratory failure and related indications: a review. JAMA. 2019;322:557\u201368.","journal-title":"JAMA"},{"key":"3649_CR25","first-page":"7","volume":"16","author":"DJ Lederer","year":"2019","unstructured":"Lederer DJ, Bell SC, Branson RD, Chalmers JD, Marshall R, Maslove DM, et al. Control of confounding and reporting of results in causal inference studies. Guidance for Authors from Editors of Respiratory, Sleep, and Critical Care Journals. Ann Am Thorac Soc. 2019;16:7.","journal-title":"Ann Am Thorac Soc"}],"container-title":["Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13054-021-03649-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13054-021-03649-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13054-021-03649-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T12:04:20Z","timestamp":1625659460000},"score":1,"resource":{"primary":{"URL":"https:\/\/ccforum.biomedcentral.com\/articles\/10.1186\/s13054-021-03649-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,7]]},"references-count":25,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["3649"],"URL":"https:\/\/doi.org\/10.1186\/s13054-021-03649-8","relation":{},"ISSN":["1364-8535"],"issn-type":[{"value":"1364-8535","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,7]]},"assertion":[{"value":"6 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 June 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 July 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All participating ICUs obtained Institutional Review Board approval by following their local regulations. Besides the dataset used for the analysis was de-identifed.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Dr Combes reports grants from Getinge, personal fees from Getinge, Baxter and Xenios outside the submitted work. Dr Combes is also the recent past president of the EuroELSO organization and a member of the executive and scientific committees for ECMONet Dr Schmidt reported personal fees from Getinge, Drager, and Xenios, outside the submitted work. Dr Schmidt is also member of the Data Committee for ECMONet. Dr. Brodie receives research support from ALung Technologies. He has been on the medical advisory boards for Baxter, Abiomed, Xenios and Hemovent. Dr. Brodie is also the President-elect of the Extracorporeal Life Support Organization (ELSO) and the Chair of the Executive Committee of the International ECMO Network (ECMONet). The other authors declare that they have no conflicts of interest related to the purpose of this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"238"}}