Abstract
ObjectivePerforming tracheotomy in patients with COVID-19 carries a risk of transmission to the surgical team due to potential viral particle aerosolization. Few studies have reported transmission rates to tracheotomy surgeons. We describe our safety practices and the transmission rate to our surgical team after performing tracheotomy on patients with COVID-19 during the peak of the pandemic at a US epicenter.Study DesignRetrospective cohort study.SettingTertiary academic hospital.MethodsTracheotomy procedures for patients with COVID-19 that were performed April 15 to May 28, 2020, were reviewed, with a focus on the surgical providers involved. Methods of provider protection were recorded. Provider health status was the main outcome measure.ResultsThirty-six open tracheotomies were performed, amounting to 65 surgical provider exposures, and 30 (83.3%) procedures were performed at bedside. The mean time to tracheotomy from hospital admission for SARS-CoV-2 symptoms was 31 days, and the mean time to intubation was 24 days. Standard personal protective equipment, according to Centers for Disease Control and Prevention, was worn for each case. Powered air-purifying respirators were not used. None of the surgical providers involved in tracheotomy for patients with COVID-19 demonstrated positive antibody seroconversion or developed SARS-CoV-2–related symptoms to date.ConclusionTracheotomy for patients with COVID-19 can be done with minimal risk to the surgical providers when standard personal protective equipment is used (surgical gown, gloves, eye protection, hair cap, and N95 mask). Whether timing of tracheotomy following onset of symptoms affects the risk of transmission needs further study.
Highlights
Thirty-six open tracheotomies were performed, amounting to 65 surgical provider exposures, and 30 (83.3%) procedures were performed at bedside
Tracheotomy for patients with COVID-19 can be done with minimal risk to the surgical providers when standard personal protective equipment is used
One major consideration is the potential risk of transmission from the patient to the health care team, as this procedure can be a source of aerosolized virus during and after tracheotomy tube placement
Summary
Tracheotomy procedures for patients with COVID19 that were performed April 15 to May 28, 2020, were reviewed, with a focus on the surgical providers involved. Provider health status was the main outcome measure. A retrospective chart review was completed of all patients requiring prolonged intubation due to SARS-CoV-2 infection who underwent tracheotomy by the otolaryngology service at Montefiore Medical Center. The research was approved by the Institutional Review Board at the Albert Einstein College of Medicine. Providers in our department involved in tracheotomy were surveyed regarding the protective measures taken during tracheotomy, presence of COVID-19 symptoms, results of SARS-CoV-2 testing, and antibody status before and after involvement in tracheotomy procedures
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