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Performing tracheostomy during the Covid-19 pandemic: guidance and recommendations from the Critical Care and Acute Care Surgery Committees of the American Association for the Surgery of Trauma
  1. Christopher P Michetti1,
  2. Clay Cothren Burlew2,
  3. Eileen M Bulger3,
  4. Kimberly A Davis4,
  5. David A Spain5
  6. the Critical Care and Acute Care Surgery Committees of the American Association for the Surgery of Trauma
  1. 1 Department of Surgery, Inova Fairfax Hospital, Falls Church, Virginia, USA
  2. 2 Department of Surgery, Denver Health, Denver, Colorado, USA
  3. 3 Department of Surgery, University of Washington, Seattle, Washington, USA
  4. 4 Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
  5. 5 Department of Surgery, Stanford University, Stanford, California, USA
  1. Correspondence to Dr Christopher P Michetti; Christopher.Michetti{at}inova.org

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Background

As the Covid-19 pandemic evolves, acute care surgeons, intensivists and other surgical specialists increasingly may be asked to perform a tracheostomy in patients with known or suspected coronavirus-19 infection. Practitioners must be prepared for this inevitability while taking measures to perform the procedure safely for patients in altered or suboptimal conditions and protecting themselves and other healthcare personnel from undue risk of exposure and infection. This document provides a brief overview for those considering performing tracheostomy in known or suspected Covid-19. The information provided here is not intended to supersede clinical judgment. As the current pandemic evolves, some or all of the data and recommendations may not be applicable to future conditions.

Current severity of disease in the Covid-19 population

As of 26 March 2020, the Centers for Disease Control and Prevention (CDC) reported 68 440 total confirmed plus presumptive cases of Covid-19 in the USA, with 994 deaths.1 These numbers are expected to change daily as more data are collected and more testing for the virus is performed. As of 16 March 2020, the last report of outcome data by the CDC,2 508 patients were known to have been hospitalized in the USA, with 121 (23.8%) admitted to an intensive care unit (ICU). ICU admissions were highest among adults 75–84 years old and lowest among adults 20–44 years old. Among the 44 cases with a known outcome, 80% of deaths have been in patients 65 years of age or older and 20% among adults 20–64 years of age. The largest percentage of severe outcomes are in those 85 years of age or older.

The early experience from Wuhan, China, on 138 hospitalized patients reported that 36 (26.1%) were admitted to ICU for complications, 22 (61.1%) of whom were diagnosed with ARDS and 17 (47.2%) of whom were placed on mechanical ventilation.3 Discharge data were incomplete, …

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