ABSTRACT
Introduction: Tracheostomies have been performed in patients with prolonged intubation due to COVID-19, but the optimal timing, patient selection, and long-term outcomes largely remain unknown. Method: A prospectively collected database of patients with COVID-19 undergoing open tracheostomy at a major medical center in New York City between March 2020 and April 2020 was reviewed. Primary endpoints were weaning from the ventilator and sedation and time to decannulation. Secondary endpoints included both immediate and long-term complication rates as well as intensive care unit and hospital discharge. Results: In total, 61 patients underwent tracheostomy. There were 38 men (62.3%) and 28 women (37.7%) with an average age of 62 years (SD 13.7;range 23-91 years). Patients were intubated for a median time of 26 days prior to tracheostomy (interquartile range [IQR] 23-30 days). The median time to weaning from ventilatory support after tracheostomy was 18 days (IQR 10-27 days). Of those sedated at the time of tracheostomy, the median time to discontinuation of sedation was 5 days (IQR 3-9 days). Of patients who survived, 35 patients (60.3%) were decannulated. Of those decannulated (n = 33) before discharge, the median time to decannulation was 36 days following tracheostomy (IQR 27-48 days). Time from ventilator liberation to decannulation was 14 days (IQR 7-18 days). Fourteen patients (23.0%) had minor bleeding managed with packing. Two patients (3.3%) had bleeding requiring neck exploration. The all-use mortality rate was 9.4%. No patients died of procedural uses. No attending surgeons contracted COVID-19. Conclusion: Open tracheostomies were successfully and safely performed at our institution in the peak of the COVID- 19 pandemic. Most patients were successfully weaned from the ventilator and sedation. Approximately 60% of patients were decannulated prior to hospital discharge.