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

A systematic review and meta-analysis of the entire COVID-19 Tracheostomy cohort was conducted to determine the cumulative incidence of complications, mortality, time to decannulation and ventilatory weaning Outcomes of surgical versus percutaneous and outcomes relative to tracheostomy timing were also analysed Studies reporting outcome data on patients with COVID-19 undergoing tracheostomy were identified and screened by 2 independent reviewers Preferred Reporting Items or Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed Outcome data were analysed using a random-effects model From 1016 unique studies, 39 articles reporting outcomes for a total of 3929 patients were included for meta-analysis Weighted mean follow-up time was 42 03 ± 26 days post-tracheostomy Meta-analysis showed that 61 2% of patients were weaned from mechanical ventilation [95%CI 52 6%-69 5%], 44 2% of patients were decannulated [95%CI 33 96%-54 67%], and cumulative mortality was found to be 19 23% [95%CI 15 2%-23 6%] across the entire tracheostomy cohort The cumulative incidence of complications was 14 24% [95%CI 9 6%-19 6%], with bleeding accounting for 52% of all complications No difference was found in incidence of mortality (RR1 96;p = 0 34), decannulation (RR1 35, p = 0 27), complications (RR0 75, p = 0 09) and time to decannulation (SMD 0 46, p = 0 68) between percutaneous and surgical tracheostomy Moreover, no difference was found in mortality (RR1 57, p = 0 43) between early and late tracheostomy, and timing of tracheostomy did not predict time to decannulation 10 confirmed nosocomial staff infections were reported from 1398 tracheostomies This study provides an overview of outcomes of tracheostomy in COVID-19 patients, and contributes to our understanding of tracheostomy decisions in this patient cohort