Tracheostomy in COVID-19 - safety and 30-day outcomes of the first 100 cases from a single tertiary UK hospital: a prospective observational cohort study

Bangash, Mansoor N.; Breik, Omar; Dawson, Camilla; Idle, Matthew; Isherwood, Peter; Jennings, Christopher; Keene, Damian; Manji, Mav; Martin, Tim; Moss, Rob; Murphy, Nick; Nankivell, Paul; Parekh, Dhruv; Parmar, Sat; Patel, Jaimin; Pracy, Paul; Praveen, Prav; Richardson, Carla; Richter, Alex; Sachdeva, Rajneesh; Sharma, Neil; Shields, Adrian; Siddiq, Somiah; Smart, Simon; Tasker, Laura

BACKGROUND: The role of tracheostomy in 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 that underwent tracheostomy at our institution. METHODS: This was a prospective observational cohort study of patients confirmed to have COVID-19 that required mechanical ventilation at Queen Elizabeth Hospital, Birmingham, UK. The primary outcome measure was 30-day survival, accounting for severe organ dysfunction [APACHE-II score>17]. Secondary outcomes included duration of ventilation, ICU stay and healthcare workers directly involved in tracheostomy care acquiring COVID-19. RESULTS: 164 COVID-19 patients were admitted to ICU between March 9(th)-April 21(st) 2020. 100 patients (mean (SD) age:55 (12); 29% female) underwent tracheostomy; 64 (age: 57 (14); 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.