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.