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

AbstractPurposeCOVIDTrach 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.MethodAn 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.ResultsThe 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.ConclusionsTracheostomy 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.FundingThe COVIDTrach project is supported by the Wellcome Trust UCL COVID-19 Rapid Response Award and the National Institute for Health Research.Trial registrationThe study is registered with ClinicalTrials.Gov (NCT04572438).