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<jats:title>Abstract</jats:title><jats:sec><jats:title>Purpose</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Funding</jats:title><jats:p>The COVIDTrach project is supported by the Wellcome Trust UCL COVID-19 Rapid Response Award and the National Institute for Health Research.</jats:p></jats:sec><jats:sec><jats:title>Trial registration</jats:title><jats:p>The study is registered with <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://ClinicalTrials.Gov">ClinicalTrials.Gov</jats:ext-link> (<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="clintrialgov" xlink:href="NCT04572438">NCT04572438</jats:ext-link>).</jats:p></jats:sec>

Original publication

DOI

10.1101/2020.10.20.20216085

Type

Journal article

Publisher

Cold Spring Harbor Laboratory

Publication Date

27/10/2020