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

Queen Elizabeth Hospital Birmingham COVID-19 airway team, Omar Breik, Paul Nankivell, Neil Sharma, Mansoor N Bangash, Camilla Dawson, 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, Queen Elizabeth Hospital Birmingham COVID-19 airway team, Omar Breik, Paul Nankivell, Neil Sharma, Mansoor N Bangash, Camilla Dawson, 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

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; SARS-CoV-2; safety; tracheostomy.

Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

Figures

Fig 1
Fig 1
Kaplan–Meier plot for 30-day survival from date of intubation. Number at risk detailed below chart. (a) All patients stratified by tracheostomy. (b) All patients stratified by APACHE II score. (c) All patients with APACHE II scoreP<0.05 used for significance as calculated by the log rank test. APACHE, Acute Physiology and Chronic Health; ICU, Intensive Care Unit.

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