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

## TL;DR

This paper presents a safe and quick method for performing bedside open tracheostomies in COVID-19 patients, reducing risks for both patients and healthcare workers.

## Contribution

The paper introduces a validated bedside open tracheostomy protocol for COVID-19 patients with no reported complications or viral transmission.

## Key findings

- Bedside open tracheostomy took an average of 9 minutes with no complications.
- No healthcare professionals involved in the procedure reported acute COVID-19 infection.
- The method minimized risks of viral transmission while optimizing patient outcomes.

## Abstract

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.

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.

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.

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.

Key words:Tracheostomy, Covid-19, SARS-CoV-2, aerosol-generating procedure.