Cricotracheostomy for Patients with Severe COVID-19: A Case Control Study

Overview

Journal Front Surg

Specialty General Surgery

Date 2023 Feb 3

PMID 36733889

Authors

Naoki Mukai

Masahiro Okada

Saki Konishi

Mitsuo Okita

Siro Ogawa

Kosuke Nishikawa

Suguru Annen

Muneaki Ohshita

Hironori Matsumoto

Satoru Murata

Yutaka Harima

Satoshi Kikuchi

Shiori Aibara

Hirofumi Sei

Kunihide Aoishi

Rie Asayama

Eriko Sato

Taro Takagi

Kaori Tanaka-Nishikubo

Masato Teraoka

Naohito Hato

Jun Takeba

Norio Sato

Affiliations

Soon will be listed here.

Abstract

Background: Tracheostomy is an important procedure for the treatment of severe coronavirus disease-2019 (COVID-19). Older age and obesity have been reported to be associated with the risk of severe COVID-19 and prolonged intubation, and anticoagulants are often administered in patients with severe COVID-19; these factors are also related to a higher risk of tracheostomy. Cricotracheostomy, a modified procedure for opening the airway through intentional partial cricoid cartilage resection, was recently reported to be useful in cases with low-lying larynx, obesity, stiff neck, and bleeding tendency. Here, we investigated the usefulness and safety of cricotracheostomy for severe COVID-19 patients.

Materials And Methods: Fifteen patients with severe COVID-19 who underwent cricotracheostomy between January 2021 and April 2022 with a follow-up period of ≥ 14 days were included in this study. Forty patients with respiratory failure not related to COVID-19 who underwent traditional tracheostomy between January 2015 and April 2022 comprised the control group. Data were collected from medical records and comprised age, sex, body mass index, interval from intubation to tracheostomy, use of anticoagulants, complications of tracheostomy, and decannulation.

Results: Age, sex, and days from intubation to tracheostomy were not significantly different between the COVID-19/cricotracheostomy and control/traditional tracheostomy groups. Body mass index was significantly higher in the COVID-19 group than that in the control group ( = 0.02). The rate of use of anticoagulants was significantly higher in the COVID-19 group compared with the control group ( < 0.01). Peri-operative bleeding, subcutaneous emphysema, and stomal infection rates were not different between the groups, while stomal granulation was significantly less in the COVID-19 group ( = 0.04).

Conclusions: These results suggest that cricotracheostomy is a safe procedure in patients with severe COVID-19.

References

Allgood S, Peters J, Benson A, Maragos C, McIltrot K, Slater T . Acquired laryngeal and subglottic stenosis following COVID-19-Preparing for the coming deluge. J Clin Nurs. 2021; 33(1):6-10. PMC: 8446981. DOI: 10.1111/jocn.15992. View

Nishio N, Hiramatsu M, Goto Y, Shindo Y, Yamamoto T, Jingushi N . Surgical strategy and optimal timing of tracheostomy in patients with COVID-19: Early experiences in Japan. Auris Nasus Larynx. 2020; 48(3):518-524. PMC: 7674116. DOI: 10.1016/j.anl.2020.11.004. View

Staibano P, Levin M, McHugh T, Gupta M, Sommer D . Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg. 2021; 147(7):646-655. PMC: 8160928. DOI: 10.1001/jamaoto.2021.0930. View

McGrath B, Wallace S, Lynch J, Bonvento B, Coe B, Owen A . Improving tracheostomy care in the United Kingdom: results of a guided quality improvement programme in 20 diverse hospitals. Br J Anaesth. 2020; 125(1):e119-e129. DOI: 10.1016/j.bja.2020.04.064. View

Wagner C, Griesel M, Mikolajewska A, Mueller A, Nothacker M, Kley K . Systemic corticosteroids for the treatment of COVID-19. Cochrane Database Syst Rev. 2021; 8:CD014963. PMC: 8406706. DOI: 10.1002/14651858.CD014963. View

Piazza C, Lancini D, Filauro M, Sampieri C, Bosio P, Zigliani G . Post-COVID-19 airway stenosis treated by tracheal resection and anastomosis: a bicentric experience. Acta Otorhinolaryngol Ital. 2022; 42(2):99-105. PMC: 9132000. DOI: 10.14639/0392-100X-N1952. View

Gao Y, Ding M, Dong X, Zhang J, Azkur A, Azkur D . Risk factors for severe and critically ill COVID-19 patients: A review. Allergy. 2020; 76(2):428-455. DOI: 10.1111/all.14657. View

Kano M, Hasegawa H . Cricotracheostomy: new technique to open an airway in emergencies with partial resection of the cricoid cartilage. Br J Oral Maxillofac Surg. 2016; 55(1):84-85. DOI: 10.1016/j.bjoms.2016.05.004. View

Al-Samkari H, Karp Leaf R, Dzik W, Carlson J, Fogerty A, Waheed A . COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection. Blood. 2020; 136(4):489-500. PMC: 7378457. DOI: 10.1182/blood.2020006520. View

10.

. COVIDTrach: a prospective cohort study of mechanically ventilated patients with COVID-19 undergoing tracheostomy in the UK. BMJ Surg Interv Health Technol. 2021; 3(1):e000077. PMC: 8275367. DOI: 10.1136/bmjsit-2020-000077. View

11.

Zhou S, Yang Y, Zhang X, Li Z, Liu X, Hu C . Clinical Course of 195 Critically Ill COVID-19 Patients: A Retrospective Multicenter Study. Shock. 2020; 54(5):644-651. DOI: 10.1097/SHK.0000000000001629. View

12.

Tang Y, Wu Y, Zhu F, Yang X, Huang C, Hou G . Tracheostomy in 80 COVID-19 Patients: A Multicenter, Retrospective, Observational Study. Front Med (Lausanne). 2021; 7:615845. PMC: 7793766. DOI: 10.3389/fmed.2020.615845. View

13.

Piazza C, Filauro M, Dikkers F, Nouraei S, Sandu K, Sittel C . Long-term intubation and high rate of tracheostomy in COVID-19 patients might determine an unprecedented increase of airway stenoses: a call to action from the European Laryngological Society. Eur Arch Otorhinolaryngol. 2020; 278(1):1-7. PMC: 7275663. DOI: 10.1007/s00405-020-06112-6. View

14.

Demeulemeester F, de Punder K, van Heijningen M, van Doesburg F . Obesity as a Risk Factor for Severe COVID-19 and Complications: A Review. Cells. 2021; 10(4). PMC: 8073853. DOI: 10.3390/cells10040933. View

15.

Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J . Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect. 2020; 81(2):e16-e25. PMC: 7177098. DOI: 10.1016/j.jinf.2020.04.021. View

16.

Kwak P, Connors J, Benedict P, Timen M, Wang B, Zhang Y . Early Outcomes From Early Tracheostomy for Patients With COVID-19. JAMA Otolaryngol Head Neck Surg. 2020; 147(3):239-244. PMC: 7747038. DOI: 10.1001/jamaoto.2020.4837. View

17.

Bier-Laning C, Cramer J, Roy S, Palmieri P, Amin A, Anon J . Tracheostomy During the COVID-19 Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries. Otolaryngol Head Neck Surg. 2020; 164(6):1136-1147. DOI: 10.1177/0194599820961985. View

18.

Zuazua-Gonzalez A, Collazo-Lorduy T, Coello-Casariego G, Collazo-Lorduy A, Leon-Soriano E, Torralba-Moron A . Surgical Tracheostomies in COVID-19 Patients: Indications, Technique, and Results in a Second-Level Spanish Hospital. OTO Open. 2020; 4(3):2473974X20957636. PMC: 7495941. DOI: 10.1177/2473974X20957636. View

19.

Fukushima K, Yamada Y, Fujiwara S, Tanaka M, Kobayashi T, Yajima K . Development of a Risk Prediction Score to Identify High-Risk Groups for the Critical Coronavirus Disease 2019 (COVID-19) in Japan. Jpn J Infect Dis. 2021; 74(4):344-351. DOI: 10.7883/yoken.JJID.2020.789. View

20.

Piccin O, Albertini R, Caliceti U, Cavicchi O, Cioccoloni E, Dematte M . Early experience in tracheostomy and tracheostomy tube management in Covid-19 patients. Am J Otolaryngol. 2020; 41(4):102535. PMC: 7204652. DOI: 10.1016/j.amjoto.2020.102535. View