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YOUR INTENSIVE CARE HOTLINE - Quick Tip for Families in ICU: Can a Tracheostomy be Done While your Loved One is on ECMO?

/ Patrik Hutzel - Critical Care Nurse Consultant / No Comments

Quick Tip for Families in ICU: Can a Tracheostomy be Done While your Loved One is on ECMO?

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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

Today’s tip is, can a tracheostomy be done for patients on ECMO? So let’s dive right into it. When patients are on ECMO, they are most of the time, almost all the time on heparin. Heparin is a blood thinner that is needed for ECMO because blood is getting extracted, runs through plastic circuits and runs through the ECMO filter to oxygenate the blood and also remove carbon dioxide. It’s basically taking over, ECMO is taking over the function of the lung or of the heart. And because the formation of a blood clot is very likely if blood runs through a plastic tube and through a filter, heparin is needed to coagulate the blood and decrease the likelihood of blood clots to develop. A blood clot quite frankly, when someone is on ECMO could be deadly.

On the other hand, if someone is having a heparin on ECMO, the risk of a bleed is also real because the therapeutic range of the APTT, APTT is basically the range or the physiological range when blood should clot which is around from memory 28 to 35, needs to be higher because again, to decrease the risk of blood clot formation. That means heparin is running and blood is being coagulated and very thin.

Now with that said, to do a tracheostomy, the risk is very high because the risk of a bleed after or during a tracheostomy is very high. And therefore heparin can’t really be stopped while someone is on heparin. So the risk is very high. Can it be done? Yes, it can be done. Heparin can be stopped. FFPs (fresh frozen plasma) can be given. Sometimes platelets can be given and a tracheostomy can be done. But the risk is fairly high and the pros and the cons need to be weighed up what is in the best interest of a critically ill patient in that situation.

So that is my quick tip for today.

If you have a loved one in intensive care, go and check out intensivecarehotline.com. Call us on one of the numbers on the top of the website.

Like this video, comment down below what questions and insights you have from this video and subscribe to my YouTube channel for updates for families in intensive care.

This is Patrik Hutzel from intensivecarehotline.com and I’ll talk to you in a few days.

 

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