Background
The SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2)
which causes COVID-19 infection (coronavirus disease 2019) has
dramatically changed the way that physicians approach airway procedures.
SARS-CoV-2 affects multiple levels of the aerodigestive tract. Viral
loads in the lower respiratory tract samples (sputum) appear to be
significantly higher compared to those from nasal or throat
swabs1. Although the exact route of transmission is
not well defined, SARS-CoV-2 is thought to be spread via a combination
of contact, droplet, and airborne routes2. The Centers
for Disease Control and Prevention has recommended use of personal
protective equipment for both patients and healthcare personnel in order
to decrease risk of transmission; this entails that patients use
facemasks and providers utilize isolation gowns, gloves, N95
respirators, and face shields or goggles3. Commonly
performed airway procedures including intubation, direct laryngoscopy,
bronchoscopy, and tracheostomy placement have a high risk of aerosol
generation. Airway providers have reflected on ways to mitigate the
transmission risks especially when approaching a surgical airway.
Several academic organizations have outlined new recommendations for
tracheostomy placement in the setting of the COVID-19
pandemic4-7. To standardize institutional safety
measures with tracheostomy, we advocate using a dedicated tracheostomy
time-out applicable to all patients including those suspected of having
COVID-19 (Figure 1). The aim of this specific tracheostomy time-out is
to reduce preventable errors that may increase the risk of transmission
of SARS-CoV-2 .