Up to one-third of admissions to the cardiac intensive care unit are for a major heart attack, also known as acute myocardial infarction. Heart attacks are one of the leading causes of respiratory insufficiency, or the inability to properly breathe.
Patients with respiratory failure who require invasive mechanical ventilation for extended periods of time may require a tracheostomy, a ventilatory mechanism through the trachea. Acute myocardial infarction patients require an antiplatelet regimen to thin the blood and prohibit clumping in the arteries. This antiplatelet regimen often cannot be stopped and may increase the risk of bleeding from tracheostomy.
Until now, there has been limited data on both the number of patients with heart attacks requiring tracheostomy and the impact that antiplatelet therapy has on patient outcomes.
Utilizing the Vizient Clinical Data Base, 26,435 heart attack patients requiring invasive mechanical ventilation were identified. Grammatico et al. discovered that approximately 1 in 20 intubated patients presenting with acute myocardial infarction undergo a tracheostomy. In addition, patients who did not have a pause in their dual anti-platelet therapy regimen had lower in-hospital mortality compared to those whose treatment was held for the procedure. The results suggest that a dual anti-platelet therapy regimen should not be a barrier to tracheostomy placement for patients with acute myocardial infarction.
This research is highly relevant to the care and management of patients with acute myocardial infarction with respiratory failure in the cardiac intensive care unit setting.
To learn more, read the article, “Tracheostomy in Patients with Acute Myocardial Infarction and Respiratory Failure.”
Grammatico M, Banna S, Shahu A, Gastanadui MG, Jimenez JV, Heck C, Arias-Olson A, Thomas A, Ali T, Miller PE. Tracheostomy in Patients with Acute Myocardial Infarction and Respiratory Failure. J Intensive Care Med. 2024 May 7:8850666241253202. doi: 10.1177/08850666241253202. Epub ahead of print. PMID: 38715423.