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

Abstract

Objectives/Hypothesis: The COVID-19 pandemic has resulted in a dramatic increase in the number of patients requiring prolonged mechanical ventilation. Few studies have reported COVID-19 specific tracheotomy outcomes, and the optimal timing and patient selection criteria for tracheotomy remains undetermined. We delineate our outcomes for tracheotomies performed on COVID-19 patients during the peak of the pandemic at a major epicenter in the United States.Methods: This is a retrospective observational cohort study. Mortality, ventilation liberation rate, complication rate, and decannulation rate were analyzed.Results: Sixty-four patients with COVID-19 underwent tracheotomy between April 1, 2020 and May 19, 2020 at two tertiary care hospitals in Bronx, New York. The average duration of intubation prior to tracheotomy was 20 days ((interquartile range [IQR] 16.5-26.0). The mortality rate was 33% (n = 21), the ventilation liberation rate was 47% (n = 30), the decannulation rate was 28% (n = 18), and the complication rate was 19% (n = 12). Tracheotomies performed by Otolaryngology were associated with significantly improved survival (P < .05) with 60% of patients alive at the conclusion of the study compared to 9%, 12%, and 19% of patients undergoing tracheotomy performed by Critical Care, General Surgery, and Pulmonology, respectively.Conclusions: So far, this is the second largest study describing tracheotomy outcomes in COVID-19 patients in the United States. Our early outcomes demonstrate successful ventilation liberation and decannulation in COVID-19 patients. Further inquiry is necessary to determine the optimal timing and identification of patient risk factors predictive of improved survival in COVID-19 patients undergoing tracheotomy.

Systematic review and meta-analysis of tracheostomy outcomes in COVID-19 patients

“…37 studies included mortality data, irrespective of subgrouping. Of the 3876 patients included across these 37 studies, 824 patients had died by the time of follow-up [24][25][26][27][28][29][30][31][32][33][35][36][37][38][39][40][41][41][42][43][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62] . Only 14 studies explicitly reported a mean follow-up duration, giving a combined weighted mean of 42.03 days (SD 26.43) 24,26,27,30,33,37,42,43,48,50,52,56,…”

“…Heterogeneity was found to be substantial, with I 2 95% [95%CI 94.4%-96.4%](p < 0.0001; supplementary figure 2). Mean time to decannulation was reported in 19 of the 39 studies, identifying an overall weighted mean J o u r n a l P r e -p r o o f time from intubation to decannulation of 17.70 days (SD 11.31) [25][26][27][28][30][31][32][33]38,39,41,43,46,48,49,51,52,[55][56][57]60 .…”

“…36 studies reported on the distribution of tracheostomy performed across the studied population, accounting for a total of 3744 patients [23][24][25][26][27][29][30][31][32][33]35,[37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52]54,[56][57][58][59][60][61][62] . Of 3744 patients, 2179 were performed as surgical procedures, 1457 as percutaneous and 108 as novel/hybrid procedures (table 3).…”

“…To overcome the limited sample size on early versus late studies, a linear regression model was fit to determine the influence of mean time to tracheostomy from intubation on time to decannulation. 16 studies reported on both time from intubation to tracheostomy and on time J o u r n a l P r e -p r o o f to decannulation, including a total of 585 decannulation events [25][26][27][28][30][31][32][33]41,43,46,48,49,51,55,57 .…”

Improving the Safety and Science of COVID‐19 Tracheostomy: Challenges and Opportunities

“…In their report of 64 ventilated patients undergoing tracheostomy for Coronavirus Disease of 2019 (COVID-19) respiratory failure, Ahmed and colleagues provide valuable insights into clinical outcomes and surgeon risk. 1 The findings emphasize how safety measures, patient selection, and data can improve care while mitigating harm. Their paper vividly illustrates the overwhelming concerns around healthcare professional safety that characterized the first wave of the pandemic.…”