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 cutoff 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.

The Zuckerkandl tubercle is a residue from the embryological development of the thyroid gland. Although it is undeniably well known in surgery, this is not so among otolaryngologists. Our objective is to highlight the importance of the Zuckerkandl tubercle, as it has proven to be a reliable point of reference to locate the upper parathyroid, the lower thyroid artery and the recurrent nerve. In order to study the Zuckerkandl tubercle, we made a prospective analysis of the posterolateral border of the thyroid lobes in 107 thyroidectomies (88 total thyroidectomies and 19 hemithyroidectomies) carried out by the same surgeon; in total, 195 thyroid lobes were analysed. The Zuckerkandl tubercle was certainly detected in 155 thyroid lobes (79.48%). The Zuckerkandl tubercle was most frequent in the right thyroid lobe (P = 0.06). When the Zuckerkandl tubercle was present, we localised the upper parathyroid due to its relationship with the tubercle in 80 right thyroid lobes (95.23%) and in 65 left (91.54%). On 147 occasions (94.83%), the recurrent nerve was directed towards the cricothyroid membrane beneath the Zuckerkandl tubercle, laterally to the tracheal surface in relation with the Berry ligament. The lower thyroid artery and some of the distal branches, such as the recurrent nerve, also ran under the Zuckerkandl tubercle. The areolar tissue underlying the Zuckerkandl tubercle is difficult to dissect, and so this protuberance constitutes a surgical difficulty but it is fundamentally helpful to find those important structures that must be preserved in thyroid surgery.

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Study findings suggest the following surgical indications: stage I, no surgery required, implement monitoring protocol; stage II, implement monitoring protocol, surgery may be required depending on tumour severity and general patient condition; and stage III, surgery always required. This system provides a method of standardising osteoma surgical decisions.