Bedside open tracheostomy in COVID-19 patients - a safe and swift approach

Background: Tracheostomy can be performed as an open surgical procedure, percutaneous, or hybrid and forms an important step in the management of patients infected with coronavirus disease 2019 (COVID-19) requiring weaning from mechanical ventilation. The purpose of this article is to share our experience to performing bedside surgical tracheostomy in COVID-19 patients in a safe and effective manner, whilst minimising the risk of viral transmission, to optimise patient outcomes and reduce risk to healthcare professionals. Material and Methods: As recommended by ENT UK, we prospectively established a COVID Airway Team within the ENT department at Birmingham Heartlands Hospital, consisting of four head and neck consultant surgeons to perform either open -bedside, open -theatre or percutaneous tracheostomy in COVID-19 patients. A specific stepwise method for bedside open surgical tracheostomy was based on ENT UK and British Laryngological Society recommendations. Results: Thirty patients underwent tracheostomy during the study period (14 bedside -open, 5 open -theatre, 11 percutaneous). Mean duration of mechanical intubation prior to bedside -open tracheostomy was 14.5 days. The average time for open -bedside tracheostomy was 9 minutes compared to 31 minutes for open -theatre. There were no significant tracheostomy related complications with bedside -open tracheostomy. No healthcare professional involved reported acute COVID-19 infection. Conclusions: We describe our effective, safe and swift approach to bedside open tracheostomy during the COVID-19 pandemic. Our experience demonstrated a short mean procedural time, with no tracheostomy-related complications and no reported viral transmission amongst the healthcare members involved.