COVIDTrach; a prospective cohort study of mechanically ventilated COVID-19 patients undergoing tracheostomy in the UK
Authors:   COVIDTrach collaborative, Hamilton NJI , Schilder AGM , Jacob T , Ambler G , Singer M , George MM , Green F , Vasanthan R , Goulder J , Jackson E , Arora A , Kumar N , Schilling C , Laha S , Ahmad I , McGrath B , Birchall MA , Tolley NS , Sandhu G , Tatla T , Sharma N , Stimpson P , Andrews P , Mercer N , Nankivell P , Breik O , Praveen P , Idle M , Martin T , Parmar S , Pracy P , Jennings C , Higginson J , Fan K , Yeung E , Osher J , Bentley R , Huppa C , Stenhouse P , Hussain K , Hodges S , Ryba F , Surda P , Bhargava EK , Amin N , Collins J , Kelly M , Ranford D , Takhar A , Tornari C , Verkerk M , Xie C , Pennell D , Al-Yaghchi C , Ritchie L , Jaafar M , Rouhani M , Ashcroft M , Cereceda-Monteoliva N , Holroyd A , Ng J , Mistry R , Ghufoor K , Warner E , O’Mahony H , Shepherd S , Bhatti N , Drewery H , Hadley J , Mulcahy A , Wilson H , Bhandari R , Griffiths M , Magos T , Balasundaram I , Heliotis M , Loizidou A , York D , Exley R , Solanki KA , Shah P , Kirticumar P , Shah A , Shannon S , Shirazian A , Bhatt Y , Dhadwal K , Jama GM , Abdi Z , Exall T , Ekpemi I , Roplekar-Bance R , Walker C , Glibbery N , Karamali K , Li A , Rovira A , Dawson D , Munroe-Gray T , Sethukumar P , Phillips J , Williamson A , Saha R , Roberts M , Lee-Six H , Misztal B , Millington S , Musalia M , Suresh S , Cardozo A , Dunbobbin M , Tse A , Shahidi S , Chachlani M , Jolly K , Fussey J , Misurati M , Osborne M , Ashok S , Aboulgheit H , Khwaja S , Anmolsingh R , Smyth C , Al-Dulaimy B , Omakobia E , Collier J , Browning T , Courtney A , Ward P , Lignos L , Lockie C , Twose P , Heyman J , Berry S , Bishop P , Kathwadia D , Hwara T , Williamson A , Kumar A , Judd O , Parker W , Davis TP , Stubington T , Ali T , Schache A , Koumoullis H , Willcocks E , Skeely L , Dempsey G , Liatsikos K , Borgatta B , Rodrigues J , Glossop A , Sen J , Lawrence N , Bennett S , Wren L , Politidis V , Dhariwal D , Winter S , Kara A , Hunt T , Tattersall G , Udall W , Hill B , Saha S , Bates L , Smart C , Park D , O’Brien R , Linhartova L , Kirkland P , Staufenberg J , Valchanov K , Buglass H , Sheikh U , Tam E , Williamson J , McGrath A , Siddiq S , Wahid NW , Griffiths H , De M , Amlani A , Deutsch P , Markham K , Hall C , Webster S , Barker O , Sykes P , Gupta A , Easthope A , Glaze S , Morris B , Bondin D , Thorley D , Kapoor K , Sirajuddin S , Fang S , van Damme F , Mattoo O , Paramasivam E , Kershaw E , Dewhurst S , Blakeley S , Chivers C , Lindsey L , Lin DJ , Burns A , Wilson A , Macartney N , Franco F , Goodwin K , Cosway B , Glore R , Cunniffe H , Keil M , Burrows S , Moult D , Zolger D , Bakmanidis J , Nair D , Kandiah S , Anwar M , Pericleous A , Hogan C , Temple R , Whitmore D , Sheikh R , Pinto R , Cook C , Broad J , Nagalotimath U , El-Tabal E , Ghaffar S , Dallison M , Leakey E , Harris R , Blair J , France E , Sanders O , Mukherjee P , Gomati A , Moir L , Groba CB , Davies-Husband C , Seymour N , Mahalingam S , Williams D , Lovett R , Lunn J , Armson A , Balfour A , Steele K , Hilliard K , Ladan S , Paul P , Tsirevelou P , Ratnam V , Turner H , Jain N , Muddaiah A , Celinski M , Smith J , Westwood J , Coakes J , Borg R , McEwan J , Tsagkovits A , Mulla O , Stobbs N , Warner G , Pratap D , Ghani Z , Rocke J , Snape S , Ghosh S , Hassaan A , Cameron M , Daudia A , Menon S , Beckett S , Siau R , Howard A , Lamont C , Blore C , Pearce C , Zakai D , Biswas S , Moorthy R , Bates J , Gill P , Riley E , Bothma P , Meghji S , Rutherford W , Lloyd A , Syndercombe A , Smith P , Keates N , Srinivasan V , Junaid M , Kumar M , Antonio T , Vijendren A , Venkatachalam V , Gonzalez I , Lechner M , Chandrasekharan D , Arya A , Brown R , Jones H , Kumar D , Sykes R , Tehan B , Walker A , Whiteside J , Cooper F , Coombs A , Wong G , Walker D , Dennis S , Hormis A , Eldahshan A , Leach L , Paw H , Colomo-Gonzalez M , Chakravarty D , Sanyal S , Mani N , Ranganathan B , Saeed H , Linton S , Thompson A , Whittaker J , Amiruddin N , Sladkowsk A , Gohil R , Abou-Foul AK , Ahmed J , Kishwan S , Walton G , Naredla P , Al-Ajami A , Wilkinson S , Okhovat S , Menon A , Mustafa S , Carey E , Vallabh N , Davies T , Alatsatianos A. , Townsley R 
Published: October 2020

Purpose

COVIDTrach is a UK multi-centre prospective cohort study project evaluating the outcomes of tracheostomy in patients with COVID-19 receiving mechanical ventilation. It also examines the incidence of SARS-CoV-2 infection among healthcare workers involved in the procedure.

Method

An invitation to participate was sent to all UK NHS departments involved in tracheostomy in COVID-19 patients. Data was entered prospectively and clinical outcomes updated via an online database (REDCap). Clinical variables were compared with outcomes using multivariable regression analysis, with logistic regression used to develop a prediction model for mortality. Participants recorded whether any operators tested positive for SARS-CoV-2 within two weeks of the procedure.

Results

The cohort comprised 1605 tracheostomy cases from 126 UK hospitals. The median time from intubation to tracheostomy was 15 days (IQR 11, 21). 285 (18%) patients died following the procedure. 1229 (93%) of the survivors had been successfully weaned from mechanical ventilation at censoring and 1049 (81%) had been discharged from hospital. Age, inspired oxygen concentration, PEEP setting, pyrexia, number of days of ventilation before tracheostomy, C-reactive protein and the use of anticoagulation and inotropic support independently predicted mortality. Six reports were received of operators testing positive for SARS-CoV-2 within two weeks of the procedure.

Conclusions

Tracheostomy appears to be safe in mechanically ventilated patients with COVID-19 and to operators performing the procedure and we identified clinical indicators that are predictive of mortality.

Funding

The COVIDTrach project is supported by the Wellcome Trust UCL COVID-19 Rapid Response Award and the National Institute for Health Research.

Trial registration

The study is registered with ClinicalTrials.Gov (NCT04572438).