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

Naoki Mukai; Masahiro Okada; Saki Konishi; Mitsuo Okita; Siro Ogawa; Kosuke Nishikawa; Suguru Annen; Muneaki Ohshita; Hironori Matsumoto; Satoru Murata; Yutaka Harima; Satoshi Kikuchi; Shiori Aibara; Hirofumi Sei; Kunihide Aoishi; Rie Asayama; Eriko Sato; Taro Takagi; Kaori Tanaka-Nishikubo; Masato Teraoka; Naohito Hato; Jun Takeba; Norio Sato

doi:10.3389/fsurg.2023.1082699

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

Front Surg. 2023 Jan 17:10:1082699. doi: 10.3389/fsurg.2023.1082699. eCollection 2023.

Authors

Naoki Mukai¹, Masahiro Okada², Saki Konishi¹, Mitsuo Okita¹, Siro Ogawa¹, Kosuke Nishikawa^{1

3}, Suguru Annen¹, Muneaki Ohshita¹, Hironori Matsumoto¹, Satoru Murata¹, Yutaka Harima¹, Satoshi Kikuchi¹, Shiori Aibara², Hirofumi Sei², Kunihide Aoishi², Rie Asayama², Eriko Sato², Taro Takagi², Kaori Tanaka-Nishikubo², Masato Teraoka², Naohito Hato², Jun Takeba¹, Norio Sato¹

Affiliations

¹ Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan.
² Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan.
³ Department of Bone and Joint Surgery, Ehime University School of Medicine, Toon, Japan.

Abstract

Background: Tracheostomy is an important procedure for the treatment of severe coronavirus disease-2019 (COVID-19). Older age and obesity have been reported to be associated with the risk of severe COVID-19 and prolonged intubation, and anticoagulants are often administered in patients with severe COVID-19; these factors are also related to a higher risk of tracheostomy. Cricotracheostomy, a modified procedure for opening the airway through intentional partial cricoid cartilage resection, was recently reported to be useful in cases with low-lying larynx, obesity, stiff neck, and bleeding tendency. Here, we investigated the usefulness and safety of cricotracheostomy for severe COVID-19 patients.

Materials and methods: Fifteen patients with severe COVID-19 who underwent cricotracheostomy between January 2021 and April 2022 with a follow-up period of ≥ 14 days were included in this study. Forty patients with respiratory failure not related to COVID-19 who underwent traditional tracheostomy between January 2015 and April 2022 comprised the control group. Data were collected from medical records and comprised age, sex, body mass index, interval from intubation to tracheostomy, use of anticoagulants, complications of tracheostomy, and decannulation.

Results: Age, sex, and days from intubation to tracheostomy were not significantly different between the COVID-19/cricotracheostomy and control/traditional tracheostomy groups. Body mass index was significantly higher in the COVID-19 group than that in the control group (P = 0.02). The rate of use of anticoagulants was significantly higher in the COVID-19 group compared with the control group (P < 0.01). Peri-operative bleeding, subcutaneous emphysema, and stomal infection rates were not different between the groups, while stomal granulation was significantly less in the COVID-19 group (P = 0.04).

Conclusions: These results suggest that cricotracheostomy is a safe procedure in patients with severe COVID-19.

Keywords: COVID-19; SARS-CoV-2; cricoid cartilage; decannulation; tracheostomy.