COVIDTrach; the outcomes of mechanically ventilated COVID-19 patients undergoing tracheostomy in the UK: Interim Report

Abstract

COVIDTrach is a UK multidisciplinary collaborative project that aims to evaluate the outcomes of tracheostomy in COVID-19 patients. It also examines the implementation of national guidance in COVID-19 tracheostomies and the incidence of COVID-19 infections amongst those health care workers involved in the procedure. An invitation to participate in an online survey tool (REDCap) was disseminated to all UK NHS departments involved in tracheostomy in mechanically ventilated COVID-19 patients via the Federation of Surgical Specialty Associations, it's subsidiary organisations and the Intensive Care Society. To date 78 hospitals have submitted 564 COVID-19 tracheostomy cases. Fifty-two percent (n=219/465) of patients who had undergone tracheostomy and were still alive, had been successfully weaned from mechanical ventilation at the point of completing the survey. The all cause in-hospital mortality following tracheostomy was 12% (n=62/530), with 3% of these (n=2/62) due to tracheostomy related complications and the remaining deaths due to COVID-19 related complications. Amongst 400 cases submitting data two weeks after the tracheostomy, no instance of COVID-19 infection amongst operators was recorded. FFP3 masks or Powered Air Purifying Respirators were used by operators in 100% of tracheostomies and a face visor or hood with face shield was available in 99% of cases. This interim report highlights early outcomes following tracheostomy in mechanically ventilated COVID-19 patients. Future reporting from COVIDTrach will include more detailed analysis at later timepoints using comparator groups in order to provide a more comprehensive assessment of tracheostomy in COVID-19.

Tracheostomy for COVID-19: business as usual?

“…The group describe that the choice of performing a surgical or percutaneous tracheostomy depended only on patient body habitus, adequate neck extension, and airway assessment. The reported 75% percutaneous tracheostomy rate is higher than most reports in the current coronavirus literature, and contrasts with a 42% percutaneous rate from other UK centres contributing to the COVIDtrach audit 30 and the 23% rate reported in a recent Spanish national report. 21 Expert opinion guiding technique for patients suffering from COVID-19 disease is influenced by a perception that the surgical approach is more controlled.…”

Tracheotomy Outcomes in 64 Ventilated COVID‐19 Patients at a High‐Volume Center in Bronx, NY

“…Mortality among patients with COVID-19 undergoing tracheotomy has been reported to range from 7% to 14% in the United States 16,17 , 12% to 14% in the United Kingdom 18,19 , 18% to 25% in Italy, 20,21 and 24% to 41% in Spain 22,23 . In our study, we report a mortality rate of 33% which likely reflects the higher incidence of pre-existing comorbidities and population characteristics among the Bronx community, both of which have been shown to increase the risk of complications in COVID-19 patients.…”

Viral Infectivity in Patients Undergoing Tracheotomy With COVID‐19: A Preliminary Study

“…The national tracheotomy audit COVIDTrach also saw delays beyond prepandemic protocols. 28 Tracheotomies in our study were undertaken within 4 days of request from the ICU team, suggesting that postponed request was the underlying reason for a delay in performing the tracheotomy. It is likely that the initial lack of knowledge regarding infectivity and patient recovery in poorly compliant lungs resulted in delays in the decision for tracheotomy.…”

“…26,27 During the COVID-19 pandemic, however, special considerations have been given to minimize risk to staff, often resulting in delays of tracheotomy, especially against the background of increased infectivity demonstrated with other coronaviruses. 8,28 No specific data on risk of contracting COVID-19 during a tracheotomy have been described to date.…”

“…Of note, no staff members involved in the surgical procedure or the tracheotomy care of these patients contracted COVID-19 during this period, mirroring results from the national tracheotomy audit review of 564 cases in COV-IDTrach. 28 While the sensitivity of cell cultures is dependent on factors ranging from cell type to culture medium and effective sampling, culture remains the gold standard in assessing infectivity. 29,30 It has been demonstrated that PCR swab positivity, or ''viral shedding,'' after the early course of disease, does not correlate with virus infectivity.…”