ObjectivesTracheostomy is usually performed to aid weaning from mechanical ventilation and facilitate rehabilitation and secretion clearance. Little is known about the safety of percutaneous tracheostomy in patients with severe COVID-19 supported on veno-venous extracorporeal membrane oxygenation (VV-ECMO). This study aims to investigate the bleeding risk of bedside percutaneous tracheostomy in patients with COVID-19 infection supported with VV-ECMO.DesignA Retrospective review of electronic data for routine care of patients on ECMO.SettingTertiary, university affiliated national ECMO centre.ParticipantsCOVID-19 patients who underwent percutaneous tracheostomy while on VV-ECMO support.InterventionsNo intervention was conducted during this study. Measurements and Main Results: Electronic medical records of 16 confirmed COVID-19 patients who underwent percutaneous tracheostomy while on VV-ECMO support, including patient demographics, severity of illness, clinical variables, procedural complications, and outcome were compared with 16 non-COVID-19 cases. SPSS statistical software was used for statistical analysis. Demographic data were compared using the chi-square test and normality assumption was test using Shapiro-Wilk test. The indications for tracheostomy in all the cases were prolonged mechanical ventilation and sedation management. None of the patients suffered a life-threatening procedural complication within 48 hours. Moderate to severe bleeding was similar in both groups. There was no difference in 30 and 90-days mortality between both groups. As per routine screening results, none of the staff involved contracted COVID-19 infection.ConclusionsIn this case series percutaneous tracheostomy during VV-ECMO in COVID-19 patients appeared to be safe and did not pose additional risks to patients or healthcare workers.