Clinical Investigation
Safety and 30-day outcomes of tracheostomy for COVID-19: a prospective observational cohort study

https://doi.org/10.1016/j.bja.2020.08.023Get rights and content
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Abstract

Background

The role of tracheostomy in coronavirus disease 2019 (COVID-19) is unclear, with several consensus guidelines advising against this practice. We developed both a dedicated airway team and coordinated education programme to facilitate ward management of tracheostomised COVID-19 patients. Here, we report outcomes in the first 100 COVID-19 patients who underwent tracheostomy at our institution.

Methods

This was a prospective observational cohort study of patients confirmed to have COVID-19 who required mechanical ventilation at Queen Elizabeth Hospital, Birmingham, UK. The primary outcome measure was 30-day survival, accounting for severe organ dysfunction (Acute Physiology and Chronic Health [APACHE]-II score>17). Secondary outcomes included duration of ventilation, ICU stay, and healthcare workers directly involved in tracheostomy care acquiring COVID-19.

Results

A total of 164 patients with COVID-19 were admitted to the ICU between March 9, 2020 and April 21, 2020. A total of 100 patients (mean [standard deviation] age: 55 [12] yr; 29% female) underwent tracheostomy; 64 (age: 57 [14] yr; 25% female) did not undergo tracheostomy. Despite similar APACHE-II scores, 30-day survival was higher in 85/100 (85%) patients after tracheostomy, compared with 27/64 (42%) non-tracheostomised patients {relative risk: 3.9 (95% confidence intervals [CI]: 2.3–6.4); P<0.0001}. In patients with APACHE-II scores ≥17, 68/100 (68%) tracheotomised patients survived, compared with 12/64 (19%) non-tracheotomised patients (P<0.001). Tracheostomy within 14 days of intubation was associated with shorter duration of ventilation (mean difference: 6.0 days [95% CI: 3.1–9.0]; P<0.0001) and ICU stay (mean difference: 6.7 days [95% CI: 3.7–9.6]; P<0.0001). No healthcare workers developed COVID-19.

Conclusion

Independent of the severity of critical illness from COVID-19, 30-day survival was higher and ICU stay shorter in patients receiving tracheostomy. Early tracheostomy appears to be safe in COVID-19.

Keywords

COVID-19
ICU
safety
SARS-CoV-2
tracheostomy

Cited by (0)

This article is accompanied by an editorial: Tracheostomy for COVID-19: business as usual? by McGrath et al., Br J Anaesth 2020:125:867–871, doi: 10.1016/j.bja.2020.08.048

Collaborators for the Queen Elizabeth Hospital Birmingham COVID-19 airway team: Omar Breik, Neil Sharma, Camilla Dawson, Mansoor N. Bangash, Matthew Idle, Peter Isherwood, Christopher Jennings, Damian Keene, Mav Manji, Tim Martin, Rob Moss, Nick Murphy, Dhruv Parekh, Sat Parmar, Jaimin Patel, Paul Pracy, Prav Praveen, Carla Richardson, Alex Richter, Rajneesh Sachdeva, Adrian Shields, Somiah Siddiq, Simon Smart, Laura Tasker and Paul Nankivell.