Revised recommendations from the CSO-HNS taskforce on performance of tracheotomy during the COVID-19 pandemic – what a difference a year makes

Abstract

Background During the early part of the COVID-19 pandemic, the Canadian Society of Otolaryngology - Head & Neck Surgery (CSO-HNS) task force published recommendations on performance of tracheotomy. Since then, our understanding of the virus has evolved with ongoing intensive research efforts. New literature has helped us better understand various aspects including patient outcomes and health care worker (HCW) risks associated with tracheotomy during the COVID-19 pandemic. Accordingly, the task force has re-evaluated and revised some of the previous recommendations. Main body Based on recent evidence, a negative reverse transcription polymerase chain reaction (RT-PCR) COVID-19 swab status is no longer the main deciding factor in the timing of tracheotomy. Instead, tracheotomy may be considered as soon as COVID-19 swab positive patients are greater than 20 days beyond initial symptoms and 2 weeks of mechanical ventilation. Furthermore, both open and percutaneous surgical techniques may be considered with both techniques showing similar safety and outcome profiles. Additional recommendations with discussion of current evidence are presented. Conclusion These revised recommendations apply new evidence in optimizing patient and health care system outcomes as well as minimizing risks of COVID-19 transmission during aerosol-generating tracheotomy procedures. As previously noted, additional evidence may lead to further evolution of these and other similar recommendations. Graphical abstract

Tracheostomy in Critically Ill COVID-19 Patients on Extracorporeal Membrane Oxygenation: A Single-Center Experience

“… 6 , 45 Our team performed tracheostomy a mean of 25.8 days from intubation, which is somewhat longer than recommendations advising assessment of tracheostomy candidacy within 10 to 14 days of intubation. 46 This potential delay in tracheostomy insertion is likely secondary to the ill-defined prognosis and heterogeneity of this patient cohort, in addition to multiple medical comorbidities experienced by patients during the third wave of the pandemic. We performed a comparison of clinical outcomes in Kohne et al 44 with our findings ( Table 4 ).…”

Percutaneous tracheostomy in the ICU: a review of the literature and recent updates

“…However, new updated guidelines recommend that tracheostomy may be considered as soon as COVID-19-positive patients are more than 20 days after initial symptoms onset and 2 weeks of IMV, regardless of RT-PCR status. Furthermore, both ST and PDT techniques may be considered with both techniques showing similar safety and outcome profile [56 ▪▪ ]. Of note, the proportion of bleeding-related complications seem to be higher among COVID-19 patients.…”

Outcomes for COVID-19 Patients Undergoing Tracheostomy With or Without Extracorporeal Membrane Oxygenation (ECMO)

“…This was exemplified by the Canadian Society of Otolaryngology-Head & Neck Surgery (CSO-HNS) task force recommendation in 2021, which recommended delaying tracheostomy until after 20 days of symptom onset and 14 days of intubation. The CSO-HNS also recommended against waiting for negative COVID-19 testing to proceed with tracheostomy and supported the safety of both open and percutaneous approaches to tracheostomy for patients and healthcare personnel when performed after these timeframes [ 13 ]. Given data supporting the overall safety of performing and caring for tracheostomies for patients with COVID-19-related ARDS, coupled with the potential benefit of early tracheostomy for these patients, the current study seeks to add to the growing body of literature evaluating the outcomes of patients undergoing open tracheostomy for COVID-19-related ARDS.…”