• Aleix Rovira, Stephen Tricklebank, Pavol Surda, Stephen Whebell, Joe Zhang, Arun Takhar, Elizabeth Yeung, Kathleen Fan, Imran Ahmed, Phillip Hopkins, Deborah Dawson, Jonathan Ball, Ram Kumar, Waqas Khaliq, Ricard Simo, and Asit Arora.
• Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK. aleix.rovira@gstt.nhs.uk.
• Eur Arch Otorhinolaryngol. 2021 Jun 1; 278 (6): 2107-2114.

PurposeThe COVID-19 pandemic placed an unprecedented demand on critical care services for the provision of mechanical ventilation. Tracheostomy formation facilitates liberation from mechanical ventilation with advantages for both the patient and wider critical care resource, and can be performed using both percutaneous dilatational and surgical techniques. We compared outcomes in those patients undergoing percutaneous dilatational tracheostomy to those undergoing surgical tracheostomy and make recommendations for provision of tracheostomy services in any future surge.MethodsMulticentre multidisciplinary retrospective observational cohort study including 201 patients with COVID-19 pneumonitis admitted to an ICU in one of five NHS Trusts within the South London Adult Critical Care Network who required mechanical ventilation and subsequent tracheostomy.ResultsPercutaneous dilatational tracheostomy was performed in 124 (62%) of patients, and surgical tracheostomy in 77 (38%) of patients. There was no difference between percutaneous dilatational tracheostomy and surgical tracheostomy in either the rate of peri-operative complications (16.9 vs. 22.1%, p = 0.46), median [IQR(range)] time to decannulation [19.0 (15.0-30.2 (5.0-65.0)] vs. 21.0 [15.5-36.0 (5.0-70.0) days] or mortality (13.7% vs. 15.6%, p = 0.84). Of the 172 patients that were alive at follow-up, two remained ventilated and 163 were decannulated.ConclusionIn patients with COVID-19 pneumonitis that require tracheostomy to facilitate weaning from mechanical ventilation, there was no difference in outcomes between those patients that had percutaneous dilatational tracheostomy compared with those that had surgical tracheostomy. Planning for future surges in COVID-19-related critical care demands should utilise all available resource and expertise.

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