Methods
As recommended by ENT UK, we established a COVID Airway Team within the
ENT department at [removed for blind peer review], consisting of
four highly experienced head and neck consultant surgeons. The choice of
tracheostomy method and setting was agreed on a case-by-case basis via a
multi-disciplinary approach. Bedside surgical tracheostomy was the
preferred option particularly in patients that were deemed at higher
risk for instability during transfer. Our aim is to perform bedside
surgical tracheostomy with maximum efficiency and safety, over the
shortest time possible.
The procedure was planned as a semi-elective to ensure availability of
the most experienced head and neck surgeons, senior anaesthetists and
highly-skilled and familiar scrub team, whilst maintaining a minimum
safe number of personnel present. No more than two surgeons per
procedure were involved. Team members are all equipped with appropriate
personal protective equipment (PPE) in accordance with World Health
Organisation (WHO) and Public Health England (PHE) guidance. A delegated
PPE officer ensures that PPE donning and doffing are performed by
healthcare members effectively. All necessary equipment was prepared by
experienced theatre nurse with reference to a standardised checklist,
and set up according to the layout demonstrated in Figure 1. Figure 2
highlights further descriptions of our bedside open surgical
tracheostomy technique, based on recommendations by ENT UK and British
Laryngological Society.