Emergent Awake Tracheotomy during the Covid-19 Pandemic

ABSTRACT

Keywords tracheotomy, COVID-19, aerosol-generating procedures, precautions, transmission The novel coronavirus disease 2019 (COVID-19) outbreak, caused by Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread throughout the world and has been declared a pandemic by the World Health Organization.1 SARS-CoV-2 remains viable in aerosols for up to 3 hours, leading to the recommendation to avoid aerosol-generating procedures (AGPs), such as tracheotomy, in patients with COVID-19.1,2 However, in patients with head and neck cancers that cause airway obstruction, a tracheotomy may be necessary. The procedure took place in a negative pressure operating room with donning of appropriate personal protective equipment (PPE) N95 respirator mask, gloves, goggles or a face shield, and a surgical cap. When participating in AGPs, personnel should wear a gown, gloves, eye protection (goggles or a disposable face shield that covers the front and sides of the face), and airway protection with N95 masks or powered air-purifying respirators (PAPRs)7 It is essential to perform proper hand hygiene before putting on and after removing PPE. Disposable materials should be discarded at the end of the case, and the room subjected to a terminal clean.4,5,7 A HEPA filter should be placed between the Y-piece of the breathing circuit and the patient's mask or tracheal tube.7 A HEPA filter should also protect the gas sampling tubing, and gases exiting the gas analyzer should be scavenged and not returned to 7 room air All traffic in and out of the OR should be minimized.4,5,7 Support staff should be dedicated to the OR to provide all materials needed throughout the case, with exchanges performed using a material exchange cart placed immediately outside the room or in the anteroom. 4,5,7 All recommended precautions were followed during this case, except for determining the patient's infection status preoperatively.