Controlled Apneic Tracheostomy in Patients with COVID-19.

Structured Abstract Objective The objective of this study was to develop a team-based institutional infrastructure for navigating management of a novel disease, to determine a safe and effective approach for performing tracheostomies in patients with COVID-19 respiratory failure, and to review outcomes of patients and healthcare personnel following implementation of this approach. Methods An interdisciplinary Task Force was constructed to develop innovative strategies for management of a novel disease. A single-institution prospective non-randomized cohort study was then conducted on patients with COVID-19 respiratory failure who underwent tracheostomy using an induced bedside apneic technique at a tertiary care academic institution between April 27th, 2020, and June 30th, 2020. Results 28 patients underwent tracheostomy with induced apnea. The median lowest procedural oxygen saturation was 95%. The median number of ventilated days following tracheostomy was 11. There were 3 mortalities (11%) due to sepsis and multiorgan failure; of 25 surviving patients, 100% were successfully discharged from the hospital and 76% are decannulated, with a median time of 26 days from tracheostomy to decannulation (range 12 - 57). There was no symptomatic disease transmission to healthcare personnel on the COVID-19 Tracheostomy Team. Conclusions Patients with respiratory failure from COVID-19 disease may benefit from tracheostomy. This can be completed effectively and safely, without viral transmission to healthcare personnel. Performing tracheostomies earlier in the course of disease may expedite patient recovery and improve ICU resource utilization. Creation of a collaborative Task Force is an effective strategic approach for management of novel disease.