Cricotracheostomy for patients with severe COVID-19: A case control study

Area of Science:

• Otolaryngology
• Critical Care Medicine
• Infectious Diseases

Background:

• Tracheostomy is crucial for severe coronavirus disease-2019 (COVID-19) management.
• Factors like older age, obesity, and anticoagulant use increase tracheostomy risk in COVID-19 patients.
• Cricotracheostomy, a modified airway procedure, is beneficial for challenging anatomy and bleeding tendencies.

Purpose of the Study:

• To evaluate the safety and usefulness of cricotracheostomy in severe COVID-19 patients.
• To compare cricotracheostomy outcomes in COVID-19 patients with traditional tracheostomy in non-COVID-19 respiratory failure patients.

Main Methods:

• A retrospective study included 15 severe COVID-19 patients undergoing cricotracheostomy and 40 non-COVID-19 patients undergoing traditional tracheostomy.
• Data collected included demographics, intubation-to-tracheostomy interval, anticoagulant use, and tracheostomy complications.
• Follow-up was at least 14 days for the cricotracheostomy group.

Main Results:

• The COVID-19 group had significantly higher body mass index and anticoagulant use compared to the control group.
• No significant differences were observed in peri-operative bleeding, subcutaneous emphysema, or stomal infection rates.
• Stomal granulation was significantly lower in the COVID-19/cricotracheostomy group (P=0.04).

Conclusions:

• Cricotracheostomy is a safe procedure for managing severe COVID-19 patients requiring airway intervention.
• The technique demonstrates comparable safety to traditional tracheostomy, with a notable reduction in stomal granulation.
• This modified approach is particularly useful in COVID-19 patients with risk factors like obesity and anticoagulant use.