Safe delivery of surgical tracheostomies in COVID-19 patients during the pandemic

Angamuthu, N.; Baker, D.; Tsui, J.; Gagasa, E.; D'Souza, R. E.

Introduction: During the corona virus disease (COVID-19) pandemic frontline units worldwide faced the challenging task of providing highrisk services (like surgical tracheostomy) while safe-guarding the very people performing the high risk procedures. The aim of our study was to assess the incidence of COVID-19 infection among staff involved in surgical tracheostomy on COVID-19 patients Method: A surgical tracheostomy protocol and operation theatre modifications were put in place at our centre, dictated by local resources staff availability and previous tracheostomy experience. Between 26/ 03/2020 and 27/05/2020, staff participating in 71 tracheostomy procedures were sent a questionnaire. The presence of COVID-19 symptoms (new onset continuous cough, fever, loss of taste and/or loss of smell) in tracheostomy staff and patient related data were analysed Result: Among the responders (72/122), compliance with personal prophylaxis equipment use was 100%. Eleven (15%,11/72) reported key COVID-19 symptoms and self-isolated. 10 had a COVID-19 swab test and three tested positive. One staff attended (1/72) hospital for symptomatic treatment, none required hospitalisation. 43/72 staff (60%) underwent a COVID-19 antibody test, 18.6% (8/43) were positive Among the tracheostomised patients, the mean age was 58 years(29- 78) and 65.5% were males. The median time from intubation to ST was 15 days (range 5-33, IQR=9). There were no tracheostomy related deaths and overall mortality was 11%(6/55) Conclusion: Safe delivery of tracheostomy during a pandemic like COVID-19 is possible with strict adherence to personnel protective equipment, surgical protocols and regulation of traffic flow in theatres to mitigate the potential transmission of COVID-19 among surgical staff Take-home Message: Compliance with PPE, adherence to tracheostomy protocol and local modifications can mitigate potential COVID-19 transmission among health care personnel .