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European Archives of Oto-Rhino-Laryngology

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01-05-2021 | COVID-19 | Head and Neck

Outcome of 1890 tracheostomies for critical COVID-19 patients: a national cohort study in Spain

Authors: Cristina Martin-Villares, Carmen Perez Molina-Ramirez, Margarita Bartolome-Benito, Manuel Bernal-Sprekelsen, COVID ORL ESP Collaborative Group (*)

Published in: European Archives of Oto-Rhino-Laryngology | Issue 5/2021

Abstract

Background

The question of an optimal strategy and outcomes in COVID-19 tracheostomy has not been answered yet. The critical focus in our case study is to evaluate the outcomes of tracheostomy on intubated COVID-19 patients.

Methods

A multicentric prospective observational study of 1890 COVID-19 patients undergoing tracheostomy across 120 hospitals was conducted over 7 weeks in Spain (March 28 to May 15, 2020). Data were collected with an innovative approach: instant messaging via WhatsApp. Outcome measurements: complications, achieved weaning and decannulation and survival.

Results

We performed 1,461 surgical (81.3%) and 429 percutaneous tracheostomies. Median timing of tracheostomy was 12 days (4–42 days) since orotracheal intubation. A close follow-up of 1616/1890 (85.5%) patients at the cut-off time of 1-month follow-up showed that in 842 (52.1%) patients, weaning was achieved, while 391 (24.2%) were still under mechanical ventilation and 383 (23.7%) patients had died from COVID-19. Decannulation among those in whom weaning was successful (n = 842) was achieved in 683 (81%) patients.

Conclusion

To the best of our knowledge, this is the largest cohort of COVID-19 patients undergoing tracheostomy. The critical focus is the unprecedented amount of tracheostomies: 1890 in 7 weeks. Weaning could be achieved in over half of the patients with follow-up. Almost one out of four tracheotomized patients died from COVID-19.

ICNAR, Great Britain Intensive Care National Audit and Research Centre (2020) ICNARC report on COVID-19 in critical care. https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports. Accessed 22 May 2020

Wu Z, McGoogan JM (2020) Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention [published online ahead of print, 2020 Feb 24]. JAMA. https://doi.org/10.1001/jama.2020.2648CrossRefPubMedPubMedCentral

Grasselli G, Zangrillo A, Zanella A et al (2020) Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy [published online ahead of print, 2020 Apr 6]. JAMA 323(16):1574–1581. https://doi.org/10.1001/jama.2020.5394CrossRefPubMedPubMedCentral

Arentz M, Yim E, Klaff L et al (2020) Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State [published online ahead of print, 2020 Mar 19]. JAMA 323(16):1612–1614. https://doi.org/10.1001/jama.2020.4326CrossRefPubMedPubMedCentral

Wang D, Hu B, Hu C et al (2020) Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China [published online ahead of print, 2020 Feb 7]. JAMA 323(11):1061–1069. https://doi.org/10.1001/jama.2020.1585CrossRefPubMedPubMedCentral

Huang C, Wang Y, Li X et al (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020 Jan 30]. Lancet 395(10223):497–506. https://doi.org/10.1016/s0140-6736(20)30183-5CrossRefPubMedPubMedCentral

Yang X, Yu Y, Xu J et al (2020) Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published correction appears in Lancet Respir Med. 2020 Apr;8(4):e26]. Respir Med 8(5):475–481

Zhou F, Yu T, Du R et al (2020) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published correction appears in Lancet. 2020 Mar 28;395(10229):1038] [published correction appears in Lancet. 2020 Mar 28;395(10229):1038]. Lancet 395(10229):1054–1062. https://doi.org/10.1016/s0140-6736(20)30566-3CrossRefPubMedPubMedCentral

Yao W, Wang T, Jiang B et al (2020) Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations [published online ahead of print, 2020 Apr 10]. Br J Anaesth. https://doi.org/10.1016/j.bja.2020.03.026CrossRefPubMedPubMedCentral

10.

Matheny Antommaria AH, Gibb TS, McGuire AL et al (2020) Ventilator triage policies during the COVID-19 pandemic at U.S. Hospitals associated with members of the association of bioethics program directors [published online ahead of print, 2020 Apr 24]. Ann Intern Med. https://doi.org/10.7326/m20-1738CrossRefPubMedCentral

11.

COVIDTrach, Nick JI Hamilton (2020) COVIDTrach; the outcomes of mechanically ventilated COVID-19 patients undergoing tracheostomy in the UK: Interim Report 22nd May 2020 medRxiv 2020.05.22.20104679. https://doi.org/10.1101/2020.05.22.20104679

12.

Parker N, Schiff B, Fritz M, Rapaport S, Schild S, Altman K et al (2020) Tracheotomy recommendations during the COVID-19 pandemic. American Academy of Otorhinolaryngology–Head & Neck Surgery.https://www.entnet.org/content/tracheotomy-recommendations-during-covid-19-pandemic

13.

Engels PT, Weitzel E, Witterick IJ, Khalili S, Corsten M, Tewfik MA et al (2020) Recommendations from the CSO-HNS taskforce on performance of tracheotomy during the COVID-19 pandemic. Canadian Society of Otolaryngology-Head and Neck Surgery. https://www.entcanada.org/wpcontent/uploads/COVID-19-Guidelines-CSOHNS-Task-Force-Mar-23-2020.pdf. Accessed 6 Apr 2020

14.

ENT-UK Guideline (2020). https://www.entuk.org/tracheostomy-guidance-duringcovid-19-pandemic

15.

Health Ministry of Spain (2020) Informe sobre la situación de COVID-19 en España nº 31. 14 de mayo de

16.

Abe T, Madotto F, Pham T et al (2018) Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries. Crit Care 22(1):195. https://doi.org/10.1186/s13054-018-2126-6CrossRefPubMedPubMedCentral

17.

Stubington TJ, Mallick AS, Garas G, Stubington E, Reddy C, Mansuri MS (2020) Tracheotomy in COVID-19 patients: optimizing patient selection and identifying prognostic indicators. Head Neck. https://doi.org/10.1002/hed.26280CrossRefPubMedPubMedCentral

18.

Riestra-Ayora J, Yanes-Diaz J, Penuelas O, Molina-Quiros C, Sanz-Fernández R, Martin-Sanz E (2020) Safety and prognosis in percutaneous vs surgical tracheostomy in 27 patients with COVID-19. Otolaryngol Head Neck Surg. https://doi.org/10.1177/0194599820931801CrossRefPubMed

19.

Piccin O, Albertini R, Caliceti U et al (2020) Early experience in tracheostomy and tracheostomy tube management in Covid-19 patients [published online ahead of print, 2020 May 7]. Am J Otolaryngol. https://doi.org/10.1016/j.amjoto.2020.102535CrossRefPubMedPubMedCentral

20.

Takhar A, Walker A, Tricklebank S et al (2020) Recommendation of a practical guideline for safe tracheostomy during the COVID-19 pandemic [published online ahead of print, 2020 Apr 21]. Eur Arch Otorhinolaryngol. https://doi.org/10.1007/s00405-020-05993-xCrossRefPubMedPubMedCentral

21.

D’Ascanio L, Latini G, Pandolfini M, Giardini D (2020) Letter to the editor regarding “corona-steps for tracheotomy in COVID-19 patients: a staff-safe method for airway management”. Oral Oncol. https://doi.org/10.1016/j.oraloncology.2020.104731CrossRefPubMedPubMedCentral

22.

Mattioli F, Fermi M, Ghirelli M et al (2020) Tracheostomy in the COVID-19 pandemic. Eur Arch Otorhinolaryngol. https://doi.org/10.1007/s00405-020-05982-0CrossRefPubMedPubMedCentral

23.

Deng ZF, Zhu T, Ding YJ et al (2020) Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 55:E009. https://doi.org/10.3760/cma.j.issn.1673-0860.2020.0009CrossRefPubMed

24.

Hiramatsu M, Nishio N, Ozaki M et al. Anesthetic and surgical management of tracheostomy in a patient with COVID-19. Auris Nasus Larynx. https://doi.org/10.1016/j.anl.2020.04.002

25.

Andriolo BN, Andriolo RB, Saconato H, Atallah ÁN, Valente O (2015) Early versus late tracheostomy for critically ill patients. Cochrane Database Syst Rev 1(1):CD007271. https://doi.org/10.1002/14651858.cd007271.pub3CrossRefPubMed

26.

Adly A, Youssef TA, El-Begermy MM, Younis HM (2018) Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review. Eur Arch Otorhinolaryngol 275(3):679–690. https://doi.org/10.1007/s00405-017-4838-7CrossRefPubMed

27.

McGrathn BA, Brenner MJ, Warrillow SJ et al (2020) Tracheostomy in the COVID-19 era: global and multidisciplinary guidance. Lancet Resp Med. https://doi.org/10.1016/S2213-2600(20)30230-7

28.

Tay JK, Khoo ML, Loh WS (2020) Surgical considerations for tracheostomy during the COVID-19 pandemic: lessons learned from the severe acute respiratory syndrome outbreak [published online ahead of print, 2020 Mar 31]. JAMA Otorhinolaryngol Head Neck Surg. https://doi.org/10.1001/jamaoto.2020.0764CrossRef

29.

Bernal-Sprekelsen M, Avilés-Jurado FX, Escudero JÁ et al (2020) Consensus document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on tracheotomy in patients with COVID-19 infection] [published online ahead of print, 2020 May 11]. Acta Otorhinolaryngol Esp. https://doi.org/10.1016/j.otorri.2020.04.002CrossRef

30.

Young D, Harrison DA, Cuthbertson BH, Rowan K, TracMan Collaborators (2013) Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA 309(20):2121–2129. https://doi.org/10.1001/jama.2013.5154CrossRefPubMed

Title: Outcome of 1890 tracheostomies for critical COVID-19 patients: a national cohort study in Spain
Authors: Cristina Martin-Villares
Carmen Perez Molina-Ramirez
Margarita Bartolome-Benito
Manuel Bernal-Sprekelsen
COVID ORL ESP Collaborative Group (*)
Publication date: 01-05-2021
Publisher: Springer Berlin Heidelberg
Keywords: COVID-19
Tracheostomy
Published in: European Archives of Oto-Rhino-Laryngology / Issue 5/2021
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-020-06220-3

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Springer Medicine

Outcome of 1890 tracheostomies for critical COVID-19 patients: a national cohort study in Spain

Abstract

Background

Methods

Results

Conclusion

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Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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