Results
During the COVID-19 period between 1st March 2020 and 1st June 2020, 30 patients with COVID-19 underwent a tracheostomy at our institution. 46.7% (n=14) underwent a bedside open tracheostomy, 16.7% (n=5) underwent open tracheostomy in a theatre setting, and 36.7% (n=11) underwent a percutaneous tracheostomy. Table 1 summarises the patient characteristics in further detail. The mean age of patients undergoing bedside open tracheostomy was 60.5 years old (48-69 years) where majority were male (n=10, 71.4%) and of Asian ethnicity (n=9, 64.3%). The mean duration of mechanical intubation prior to bedside open tracheostomy was 14.5 days. 71.4% (n=10) of patients who had undergone bedside open tracheostomy were still alive and had been successfully weaned from mechanical ventilation, with a mean duration of 17 days from tracheostomy to successful decannulation. In-hospital mortality was reported in 28.6% (n=4) in the bedside open tracheostomy group, 20%(n=5) in open-theatre group, and 18.2% (n=11) in percutaneous group. All deaths were attributed to COVID-19 related complications. No significant tracheostomy related complications were reported with bedside open tracheostomy method whilst 20% (n=1) and 9.1% (n=1) were reported in open-theatre and percutaneous approach respectively. The average operating time (from skin incision to insertion of tracheostomy tube) for bedside tracheostomy in COVID-19 patients was 9 minutes. There were no intra-operative complications reported and minimal blood loss (<20 mls) were achieved in open-bedside approach. In all cases, the operating surgeons used a Half-Face Air Purifying Respirator, visor or goggles, fluid resistant sterile theatre gown, double-gloving and head and shoe covering. There were no healthcare personnel involved that reported acute respiratory COVID-19 infection within two weeks of the procedure. All the Head and Neck surgeons had a negative outcome for COVID-19 antibodies.