Relevance: Advances in resuscitation are largely due to improvements in respiratory support, particularly in the treatment of severe cardiovascular diseases with acute respiratory syndrome, such as myocardial infarction and unstable angina. Cardiac dysfunction leads to hypoxia, which in turn worsens the prognosis.In cases of grade 2-3 acute respiratory failure, patients with cardiovascular disease receive respiratory support via a laryngotracheal tube. However, if prolonged mechanical ventilation (MV) is expected for more than 7 days, it is advisable to create a tracheostomy to adequately clean the tracheobronchial tree, which significantly reduces the risk of pneumonia. The problem is that these patients receive anticoagulants and have increased tissue bleeding.

The aim of the study was to evaluate the experience of using the method of forming an open tracheostomy in cardiovascular patients with bleeding disorders. Material and methods of the study. The study was conducted from 2023 to 2025 at the Samara Clinical Hospital No. 1 named after N.I. Pirogov. There were 13 men (56.52%) and 10 women (43.47%), aged 73.26±3.9 years. The patients were admitted to the cardiology department; examination and treatment were carried out in accordance with the clinical guidelines of the Ministry of Health of the Russian Federation for acute coronary syndrome and cardiac arrhythmias. The nature of the diseases in patients is shown in ICD-10 codes: 148.0-1 - (9 patients); 126.0 - (5); 120.0-(3); 146.1 -(1); 125.2-(1); 135.2 - (1); 142.0-(1); 105.2-(1); 122.0-(1). As their condition worsened, all patients were transferred to the intensive care unit, where they received respiratory support with artificial ventilation via a laryngotracheal tube. All patients received intensive care based on emerging complications, monitored by computed tomography, electrocardiography, and

echocardiography, with coagulation profiles and blood biochemistry. Blood osmolarity and lactate levels were monitored, as well as cardiac troponins and blood gases. The patients' APACHE II severity score was 28.35±1.28, and the risk of bleeding during tracheostomy, according to the HAS-BLED scale, was 6±0.27 points. Within 5 days of the initiation of continuous mechanical ventilation, a tracheostomy was created. The method for creating a tracheostomy in patients with coagulopathy is covered by Russian Patent for Invention No. 2815285. Izmailov E.P., et al. (2023). The surgeries were performed in the operating room, with patients transferred from the intensive care unit to the operating room on an intensive care bed without being transferred to the operating table under general anesthesia. The open tracheostomy technique involves preemptive hemostasis and tissue coagulation before incision, the use of a hemostatic sponge before wound suturing, and gauze pads in the wound, which were removed within 3 days after surgery.

Results: There were no intraoperative complications in the patients. The surgical duration was 10.24 ± 0.49 minutes, and blood loss was 5.04 ± 0.95 milliliters. Of the 23 patients, 7 (30.43%) died. The following diseases were diagnosed according to ICD-10: 126.0 (3 patients); 148.0-1- (2); 125.2 - (1); 122.0-(1). On average, patients received treatment for 12.04 ± 3.68 days.

Conclusions: 1. Method for forming a tracheostomy in case of coagulopathy - Russian Federation Patent for Invention No. 2815285. Izmailov E.P., et al., (2023) demonstrated its effectiveness and reliability in patients with various cardiovascular diseases and blood coagulation disorders. The tracheostomy formation time is 10.24 ± 0.49 minutes, with blood loss of 5.04 ± 0.95 milliliters. Preference should be given to early tracheotomy, and the procedure should be performed in an operating room on an intensive care bed under general anesthesia.

Evgeny Petrovich Izmailov – Professor, Department of Anesthesiology, Resuscitation, and Emergency Medical Care, Institute of Postgraduate Studies, Samara Medical University, Ministry of Healthcare of the Russian Federation, Doctor of Medical Sciences, Associate Professor, Higher Attestation Commission.