• Tiffany N Chao, Sean P Harbison, Benjamin M Braslow, Christoph T Hutchinson, Karthik Rajasekaran, Beatrice C Go, Ellen A Paul, Leah D Lambe, James J Kearney, Ara A Chalian, Maurizio F Cereda, Niels D Martin, Andrew R Haas, Joshua H Atkins, and Christopher H Rassekh.
• Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
• Ann. Surg. 2020 Sep 1; 272 (3): e181e186e181-e186.

ObjectiveTo determine the outcomes of patients undergoing tracheostomy for COVID-19 and of healthcare workers performing these procedures.BackgroundTracheostomy is often performed for prolonged endotracheal intubation in critically ill patients. However, in the context of COVID-19, tracheostomy placement pathways have been altered due to the poor prognosis of intubated patients and the risk of transmission to providers through this highly aerosolizing procedure.MethodsA prospective single-system multi-center observational cohort study was performed on patients who underwent tracheostomy after acute respiratory failure secondary to COVID-19.ResultsOf the 53 patients who underwent tracheostomy, the average time from endotracheal intubation to tracheostomy was 19.7 days ± 6.9 days. The most common indication for tracheostomy was acute respiratory distress syndrome, followed by failure to wean ventilation and post-extracorporeal membrane oxygenation decannulation. Thirty patients (56.6%) were liberated from the ventilator, 16 (30.2%) have been discharged alive, 7 (13.2%) have been decannulated, and 6 (11.3%) died. The average time from tracheostomy to ventilator liberation was 11.8 days ± 6.9 days (range 2-32 days). Both open surgical and percutaneous dilational tracheostomy techniques were performed utilizing methods to mitigate aerosols. No healthcare worker transmissions resulted from performing the procedure.ConclusionsAlterations to tracheostomy practices and processes were successfully instituted. Following these steps, tracheostomy in COVID-19 intubated patients seems safe for both patients and healthcare workers performing the procedure.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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