Tracheostomy in COVID-19 - safety and 30-day outcomes of the first 100 cases from a single tertiary UK hospital: a prospective observational cohort study

Abstract Background The role of tracheostomy in 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 that underwent tracheostomy at our institution. Methods This was a prospective observational cohort study of patients confirmed to have COVID-19 that required mechanical ventilation at Queen Elizabeth Hospital, Birmingham, UK. The primary outcome measure was 30-day survival, accounting for severe organ dysfunction [APACHE-II score>17]. Secondary outcomes included duration of ventilation, ICU stay and healthcare workers directly involved in tracheostomy care acquiring COVID-19. Results 164 COVID-19 patients were admitted to ICU between March 9th-April 21st 2020. 100 patients (mean (SD) age:55 (12); 29% female) underwent tracheostomy; 64 (age: 57 (14); 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 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.