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Meta-Analysis
. 2021 Jun;34(3):956-967.
doi: 10.1007/s12028-020-01109-9. Epub 2020 Oct 9.

Outcomes After Tracheostomy in Patients with Severe Acute Brain Injury: A Systematic Review and Meta-Analysis

Sarah Wahlster  1 , Monisha Sharma  2 , Frances Chu  3 , Justin H Granstein  4 , Nicholas J Johnson  5 , W T Longstreth  6   7 , Claire J Creutzfeldt  6
Affiliations
Meta-Analysis

Outcomes After Tracheostomy in Patients with Severe Acute Brain Injury: A Systematic Review and Meta-Analysis

Sarah Wahlster et al. Neurocrit Care. 2021 Jun.

Abstract

Objective: To synthesize reported long-term outcomes in patients undergoing tracheostomy after severe acute brain injury (SABI).

Methods: We systematically searched PubMed, EMBASE, and Cochrane Library for studies in English, German, and Spanish between 1990 and 2019, reporting outcomes in patients with SABI who underwent tracheostomy. We adhered to the preferred reporting items for systematic reviews and meta-analyses guidelines and the meta-analyses of observational studies in epidemiology guidelines. We excluded studies reporting on less than 10 patients, mixed populations with other neurological diseases, or studies assessing highly select subgroups defined by age or procedures. Data were extracted independently by two investigators. Results were pooled using random effects modeling. The primary outcome was long-term functional outcome (mRS or GOS) at 6-12 months. Secondary outcomes included hospital and long-term mortality, decannulation rates, and discharge home rates.

Results: Of 1405 studies identified, 61 underwent full manuscript review and 19 studies comprising 35,362 patients from 10 countries were included in the meta-analysis. The primary outcome was available from five studies with 451 patients. At 6-12 months, about one-third of patients (30%; 95% confidence interval [CI] 17-48) achieved independence, and about one-third survived in a dependent state (36%, 95% CI 28-46%). The pooled short-term mortality for 19,048 patients was 12%, (95% CI 9-17%) with no significant difference between stroke (10%) and TBI patients (13%), and the pooled long-term mortality was 21% (95% CI 11-36). Decannulation occurred in 79% (95% CI 51-93%) of survivors. Heterogeneity was high for most outcome assessments (I2 > 75%).

Conclusions: Our findings suggest that about one in three patients with SABI who undergo tracheostomy may eventually achieve independence. Future research is needed to understand the reasons for the heterogeneity between studies and to identify those patients with promising outcomes as well as factors influencing outcome.

Keywords: Intracranial hemorrhage; Ischemic stroke; Severe acute brain injury; Subarachnoid hemorrhage; Tracheostomy; Traumatic brain injury.

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Conflict of interest statement

The authors report no relevant financial disclosures or conflict of interest.

Figures

Figure 1 –
Figure 1 –
Study Flow Chart
Figure 2 -
Figure 2 -
Forest plots displaying a) Long-term Functional Outcomes, b) Mortality, and c) Decannulation rates. Bösel, Rabinstein and Schneider report outcomes on mixed stroke cohorts (AIS, ICH, SAH). Gessler reports outcomes on SAH cohorts only. Wabl reports outcomes on a mixed cohort of patients with AIS, ICH, SAH and TBI.
Figure 2 -
Figure 2 -
Forest plots displaying a) Long-term Functional Outcomes, b) Mortality, and c) Decannulation rates. Bösel, Rabinstein and Schneider report outcomes on mixed stroke cohorts (AIS, ICH, SAH). Gessler reports outcomes on SAH cohorts only. Wabl reports outcomes on a mixed cohort of patients with AIS, ICH, SAH and TBI.
Figure 2 -
Figure 2 -
Forest plots displaying a) Long-term Functional Outcomes, b) Mortality, and c) Decannulation rates. Bösel, Rabinstein and Schneider report outcomes on mixed stroke cohorts (AIS, ICH, SAH). Gessler reports outcomes on SAH cohorts only. Wabl reports outcomes on a mixed cohort of patients with AIS, ICH, SAH and TBI.
Figure 2 -
Figure 2 -
Forest plots displaying a) Long-term Functional Outcomes, b) Mortality, and c) Decannulation rates. Bösel, Rabinstein and Schneider report outcomes on mixed stroke cohorts (AIS, ICH, SAH). Gessler reports outcomes on SAH cohorts only. Wabl reports outcomes on a mixed cohort of patients with AIS, ICH, SAH and TBI.
Figure 2 -
Figure 2 -
Forest plots displaying a) Long-term Functional Outcomes, b) Mortality, and c) Decannulation rates. Bösel, Rabinstein and Schneider report outcomes on mixed stroke cohorts (AIS, ICH, SAH). Gessler reports outcomes on SAH cohorts only. Wabl reports outcomes on a mixed cohort of patients with AIS, ICH, SAH and TBI.
Figure 3 –
Figure 3 –
Distribution of Long-term Functional Outcomes. Bösel,, Rabinstein and Schneider report outcomes on mixed stroke cohorts (AIS, ICH, SAH). Gessler reports outcomes on SAH cohorts only. Wabl reports outcomes on a mixed cohort of patients with AIS, ICH, SAH and TBI.
See this image and copyright information in PMC

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