Tutorial presented by Emily Le-Gallienne, Resuscitation Officer, East of England Ambulance Service

In this tutorial, Emily covers three key topics related to end-of-life care for individuals with a tracheostomy:

Dying with a Tracheostomy vs. Dying Because of a Tracheostomy:

• Clinicians should distinguish between a natural dying process and a situation where the tracheostomy contributes to the patient’s condition (e.g., displacement, obstruction).
• Patients dying naturally should not be treated differently solely because of their tracheostomy, though issues like secretion management may require attention. Holistic care, respecting advanced care plans and patient wishes, remains essential.

Admission Avoidance and Care Location:

• Many end-of-life patients unnecessarily end up in hospital due to clinician anxiety around managing tracheostomies.
  It’s important to assess whether patients can remain comfortable and supported in their preferred place of care, leveraging community and district nursing teams as needed.

Catastrophic Bleeding:

• Rare but severe bleeding, often seen in tracheostomy patients with head and neck cancers, can occur.
• Hyperinflation of the tracheostomy cuff may help reduce blood loss and should be used according to local policies. These patients typically require emergency department care.