Outcomes of Patients Undergoing Emergency Tracheostomy During COVID 19 Pandemic: Our Experience from a Tertiary Care Centre in North-East India

Abstract

Airway management in the form of tracheostomy may be done as an emergency or elective procedure depending on when the patient presents and it usually involves a multi-disciplinary team including the anesthesiologist and emergency physician. The purpose of this study is to present our experience with emergency tracheostomies carried out for patients presenting with tumors in the aerodigestive tract during this period of covid 19 pandemic and their outcomes. This is a cross sectional observational study. All the patients who underwent emergency tracheostomy at Dr. B. Borooah Cancer Institute, Guwahati, India, during the period 24th March, 2020 to 23rd September, 2020(6 months) are included in this study. A total of 115 patients underwent 117 emergency tracheostomies (two underwent redo tracheostomies). Median age of patients was 55 years. More than 85% of patients were male. The most common initial presenting complaint was dysphagia (40%) followed by dyspnea (25%). Most common site of tumor was pyriform sinus cancer (45.2%). Almost 45% of patients presented with stage IVA. Complications were seen in 10 patients (8.7%). These included stomal stenosis in 4(3.5%), primary hemorrhage in 3(2.6%), subcutaneous emphysema, infection and wound break down each in one patient (0.9% each). Among the eight residents who performed these procedures, five developed covid 19 symptoms subsequently, and were tested covid positive. Emergency tracheostomy is a safe procedure for patients; however it carries a higher risk of covid transmission despite using proper precautions.

The Impact of the COVID-19 Pandemic on Urgent Awake Tracheotomies in Adults

“…Pre-tracheotomy COVID testing reports were available for only 11 patients, and 9 of them tested positive on post-tracheotomy COVID testing. The pyriform sinus was the most prevalent tumor site (45.2%), and 45% of patients presented with stage IVA [ 15 ].…”

SARS‐CoV‐2 transmission risk to healthcare workers performing tracheostomies: a systematic review

“…Of note, SARS‐CoV‐2 transmission to two HCWs was observed in one study where non‐hospital grade snorkelling masks were used during the tracheostomy 37 . Similarly, five HCWs tested positive to COVID‐19 in one study where PPE precautions were not adhered to as patients obtained a negative COVID‐19 rapid antigen test within the preceding 7 days 38 . Reducing the use of improvised, non‐medical grade PPE should be considered given the risk of poor filtration and failed fit tests 39 .…”

“… 37 Similarly, five HCWs tested positive to COVID‐19 in one study where PPE precautions were not adhered to as patients obtained a negative COVID‐19 rapid antigen test within the preceding 7 days. 38 Reducing the use of improvised, non‐medical grade PPE should be considered given the risk of poor filtration and failed fit tests. 39 Concurrently, negative rapid antigen tests should not be used as a substitute for reducing PPE precautions during tracheostomies given the risk of poor test sensitivity and the potential for infections to occur between the negative test and the procedure.…”