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

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. In Wuhan, China, 40 of 138 hospitalized patients were healthcare providers who were infected from presumed hospital spread.6 With the current pandemic, significant attention has been focused on the safety of healthcare workers, and many organizations have published guidance on infection prevention and control for these essential personnel.9–12 Considerations for indications and timing Surgeons should consider both short-term and long-term outcomes of tracheostomy along with the risks of exposure of the clinical team. In all patients with Covid-19 who need a tracheostomy, an acceptable strategy is to wait for the disease to become non-transmissible* prior to performing a high-risk aerosol-generating procedure such as tracheostomy. *See CDC recommendations for discontinuation of transmission-based precautions.16 Procedural guidance for Open and Percutaneous Tracheostomy Here we provide practical guidance for the performance of OT and PT in patients with known or suspected Covid-19 infection. If an AIIR is not available, avoid entry into room by non-essential personnel for up to 3 hours due to persistence of viable virus in aerosols.18 Limit the number of participants in the room to essential personnel only.19 An experienced attending surgeon or other experienced practitioner should perform the procedure.