Boudreaux et al.¹ are to be commended for their publication in this month’s ASAIO regarding the utility of early tracheostomy in 150 patients placed on venovenous (VV) extracorporeal membrane oxygenation (ECMO) for respiratory failure. Thirty-five of the patients received a tracheostomy. There was no difference in survival between patients receiving a tracheostomy and those who did not (53.1% vs. 57.5%). In patients with a tracheostomy, they found significantly shorter intensive care unit (ICU) (25 vs. 36 days; p = 0.04) and hospital (33 vs. 47 days; p = 0.017) length of stay when it was performed within 7 days of ECMO cannulation. However, tracheostomy patients had longer lengths of mechanical ventilation (25.5 vs. 8 days; p < 0.01), length of intravenous (IV) sedation (17 vs. 7 days), ICU (31.5 vs. 21 days; p = 0.01) and hospital (39 vs. 30; p = 0.04), and total length of ECMO support (14 vs. 5 days) compared to patients that did not require tracheostomy despite pre-cannulation Respiratory ECMO Survival Prediction (RESP) scores.²

These results mirror previous findings by the University of Maryland group.³ They found early tracheostomy placement (<7 days) in patients placed on VV ECMO for acute respiratory distress syndrome (ARDS) to be associated with reduced time on ECMO. No change in ICU or length of stay were seen. However, no patients in this study were managed without tracheostomy.