1. COVIDTrach: a prospective cohort study of mechanically ventilated patients with COVID-19 undergoing tracheostomy in the UK
- Author
-
A Thompson, S Wilkinson, N Kumar, G Wong, J Smith, F Franco, P Smith, A Wilson, S Ghosh, S Shepherd, A Kumar, R Brown, D Williams, M Griffiths, J Sen, M Roberts, A McGrath, D Kumar, A Walker, A Gupta, N Sharma, P Shah, M Kumar, H Jones, P Paul, I Gonzalez, A Shah, V Srinivasan, M Kelly, P Surda, K Valchanov, S Saha, R Bentley, C Hall, C Pearce, R Harris, H Wilson, N Amin, J Phillips, D Park, C Jennings, L Wren, B McGrath, D Walker, J Ahmed, S Menon, N Jain, R Mistry, E Jackson, W Rutherford, E France, S Mahalingam, C Hogan, A Burns, T Exall, J Rodrigues, C Xie, M Rouhani, E Paramasivam, A WILLIAMSON, K STEELE, D Dawson, S Linton, M Cameron, S Biswas, S Hodges, J Collier, J Collins, S Bennett, T Ali, N Bhatti, S Suresh, J Williamson, G Ambler, C Cook, D Baker, J Bates, J Blair, P Mukherjee, A Howard, B Cosway, M Anwar, S Fang, S Meghji, H Griffiths, M Keil, F GREEN, K Hussain, A Schache, C Lockie, S Winter, J Westwood, P Ward, C Walker, G Sandhu, T Davies, A Lloyd, L Linhartova, C SPENCER, A Courtney, L Bates, T Martín, T Tatla, L Ritchie, P Gill, S Shannon, A Arora, R Pinto, H Turner, J Whittaker, E Warner, L Leach, A Menon, J Higginson, G Warner, A Balfour, F Cooper, A Li, S Berry, R Gohil, M Celinski, J McEwan, E Riley, S Webster, I Ahmad, M Idle, K Jolly, S Burrows, S Parmar, B Morris, A Arya, S Mustafa, E Tam, D Chakravarty, M De, A Daudia, B Tehan, R Temple, J Broad, P Andrews, D Pennell, C Smart, R D’Souza, P Praveen, DJ Lin, M Osborne, A Coombs, T Hunt, M Singer, C Smyth, R Saha, G Walton, P Bishop, U Sheikh, R O'Brien, R Bhandari, A Rovira, S Sanyal, E Yeung, A Tse, N Lawrence, P Stimpson, H Saeed, K Fan, M Ashcroft, T Jacob, J Hadley, K Goodwin, Z Abdi, D Nair, B Hill, D Whitmore, N Macartney, P Sykes, N Mercer, R Sykes, S Siddiq, Nick JI Hamilton, AGM Schilder, MM George, GM Jama, J Goulder, C Schilling, S Laha, MA Birchall, NS Tolley, P Nankivell, O Breik, P Pracy, J Osher, C Huppa, P Stenhouse, F Ryba, EK Bhargava, D Ranford, A Takhar, C Tornari, M Verkerk, C Al-Yaghchi, M Jaafar, N Cereceda-Monteoliva, A Holroyd, K Ghufoor, H O'Mahony, H Drewery, A Mulcahy, T Magos, I Balasundaram, M Heliotis, A Loizidou, D York, R Exley, KA Solanki, P Kirticumar, A Shirazian, Y Bhatt, R Natt, N Banga, K Dhadwal, I Ekpemi, R Roplekar-Bance, N Glibbery, K Karamali, T Munroe-Gray, P Sethukumar, R Vasanthan, H Lee-Six, B Misztal, S Millington, M Musalia, A Cardozo, M Dunbobbin, S Shahidi, M Chachlani, J Fussey, M Misurati, S Ashok, H Aboulgheit, S Khwaja, R Anmolsingh, B Al-Dulaimy, E Omakobia, T Browning, L Lignos, P Twose, J Heyman, D Kathwadia, T Hwara, O Judd, W Parker, TP Davis, T Stubington, H Koumoullis, E Willcocks, L Skelly, G Dempsey, K Liatsikos, B Borgatta, A Glossop, V Politidis, D Dhariwal, A Kara, G Tattersall, W Udall, P Kirkland, J Staufenberg, H Buglass, NW Wahid, A Amlani, P Deutsch, K Markham, O Barker, A Easthope, S Glaze, D Bondin, D Thorley, K Kapoor, S Sirajuddin, F van Damme, O Mattoo, E Kershaw, S Dewhurst, S Blakeley, C Chivers, L Lindsey, R Glore, H Cunniffe, D Moult, D Zolger, J Bakmanidis, S Kandiah, A Pericleous, R Sheikh, U Nagalotimath, E El-Tabal, S Ghaffar, M Dallison, E Leakey, O Sanders, A Gomati, L Moir, CB Groba, C Davies-Husband, N Seymour, R Lovett, J Lunn, A Armson, K Hilliard, S Ladan, P Tsirevelou, V Ratnam, A Muddaiah, J Coakes, R Borg, A Tsagkovits, O Mulla, N Stobbs, D Pratap, Z Ghani, J Rocke, S Snape, A Hassaan, S Beckett, R Siau, C Lamont, C Blore, D Zakai, R Moorthy, P Bothma, A Syndercombe, N Keates, M Junaid, T Antonio, A Vijendren, V Venkatachalam, M Lechner, D Chandrasekharan, J Whiteside, S Dennis, A Eldahshan, H Paw, M Colomo-Gonzalez, N Mani, B Ranganathan, N Amiruddin, A Sladkowski, AK Abou-Foul, S Kishwan, P Naredla, A Al-Ajami, S Okhovat, E Carey, N Vallabh, A. Alatsatianos, and R Townsley
- Subjects
medicine.medical_specialty ,RD1-811 ,medicine.medical_treatment ,Biomedical Engineering ,Logistic regression ,01 natural sciences ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,medicine ,Medical technology ,cohort study ,Intubation ,030212 general & internal medicine ,0101 mathematics ,R855-855.5 ,Prospective cohort study ,ear–nose–throat devices ,Original Research ,Mechanical ventilation ,business.industry ,Incidence (epidemiology) ,010102 general mathematics ,COVID-19 ,Ventilation (architecture) ,Emergency medicine ,Cohort ,Anaesthesiology Devices ,Surgery ,business ,Cohort study - Abstract
ObjectivesCOVIDTrach is a UK multicentre prospective cohort study project that aims to evaluate the outcomes of tracheostomy in patients with COVID-19 receiving mechanical ventilation and record the incidence of SARS-CoV-2 infection among healthcare workers involved in the procedure.DesignData on patient demographic, clinical history and outcomes were entered prospectively and updated over time via an online database (REDCap). Clinical variables were compared with outcomes, with logistic regression used to develop a model for mortality. Participants recorded whether any operators tested positive for SARS-CoV-2 within 2 weeks of the procedure.SettingUK National Health Service departments involved in treating patients with COVID-19 receiving mechanical ventilation.ParticipantsThe cohort comprised 1605 tracheostomy cases from 126 UK hospitals collected between 6 April and 26 August 2020.Main outcome measuresMortality following tracheostomy, successful wean from mechanical ventilation and length of time from tracheostomy to wean, discharge from hospital, complications from tracheostomy, reported SARS-CoV-2 infection among operators.ResultsThe 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, positive end-expiratory pressure setting, fever, 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 2 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 parameters that are predictive of mortality.Trial registration numberThe study is registered with ClinicalTrials.Gov (NCT04572438).
- Published
- 2021