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Coronavirus (COVID-19)

Negative-Pressure Aerosol Cover for COVID-19 Tracheostomy

Educational Objective
To understand how negative-pressure aerosol cover can decrease risk of spreading COVID-19 during tracheostomy

1 Credit CME

JAMA Otolaryngology–Head & Neck Surgery

Published Online: April 28, 2020

Research Letter

Article Information and Disclosures

J. Tyler Bertroche, MD¹;

Patrik Pipkorn, MD, MSCI¹;

Paul Zolkind, MD¹;

Craig A. Buchman, MD¹;

Jose P. Zevallos, MD, MPH¹

Author Affiliations

¹Department of Otolaryngology–Head & Neck Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri

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Because of the high virulence of the novel coronavirus responsible for causing COVID-19, many patients infected with the virus become critically ill, requiring prolonged intubation, and may ultimately require tracheostomy. Mucosal surfaces have been shown to be reservoirs for high concentrations of the virus, which can become aerosolized for up to 3 hours following manipulation.¹^,2 Surgeons performing tracheostomies are at high risk for exposure, and recently published guidelines recommend against elective, non–time-sensitive procedures.³ In the event that a tracheostomy is indicated in a patient with confirmed or suspected COVID-19, interventions that limit the spread of aerosols are critical to reducing exposure.⁴^,5 Here we present the creation of a novel negative-pressure aerosol cover made out of readily available operating room materials as an additional barrier to limit the spread of aerosols during tracheostomy.

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Article Information

Accepted for Publication: April 14, 2020.

Published Online: April 28, 2020. doi:10.1001/jamaoto.2020.1081

Correction: This article was corrected on June 11, 2020, to add missing funding information.

Corresponding Author: J. Tyler Bertroche, MD, Department of Otolaryngology–Head & Neck Surgery, Washington University in St Louis School of Medicine, 1 Barnes-Jewish Plaza, St Louis, MO 63108 (jtbertroche@wustl.edu).

Author Contributions: Drs Bertroche, Pipkorn, and Zevallos had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Bertroche, Buchman, Zevallos.

Acquisition, analysis, or interpretation of data: Bertroche, Pipkorn, Zolkind, Zevallos.

Drafting of the manuscript: Bertroche, Buchman.

Critical revision of the manuscript for important intellectual content: All authors.

Administrative, technical, or material support: Zolkind, Zevallos.

Study supervision: Pipkorn, Buchman, Zevallos.

Conflict of Interest Disclosures: Dr Buchman reported receiving grants from the US Department of Defense and consulting fees from Cochlear Limited, Advanced Bionics, Envoy, and IotaMotion outside the submitted work; in addition, Dr Buchman had a patent to US9,072,468B2 licensed. No other disclosures were reported.

Funding/Support: Research reported in this publication was supported by the Foundation for Barnes-Jewish Hospital Otolaryngology Surgical Outcomes and Quality Improvement Unit (SOQIU) at Barnes-Jewish Hospital (grant 4090).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References

Zou L , Ruan F , Huang M , et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020;382(12):1177-1179. doi:10.1056/NEJMc2001737 PubMed Google Scholar Crossref

van Doremalen N , Bushmaker T , Morris DH , et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1564-1567. doi:10.1056/NEJMc2004973 PubMed Google Scholar Crossref

Givi B , Schiff BA , Chinn SB , et al. Safety recommendations for evaluation and surgery of the head and neck during the COVID-19 pandemic [published online March 31, 2020]. JAMA Otolaryngol Head Neck Surg. 2020. doi:10.1001/jamaoto.2020.0780 PubMed Google Scholar

Parker N , Schiff B , Fritz M , et al; Airway and Swallowing Committee of the American Academy of Otolaryngology–Head and Neck Surgery. Tracheotomy recommendations during the COVID-19 pandemic. Accessed April 20, 2020. https://www.entnet.org/content/tracheotomy-recommendations-during-covid-19-pandemic

Tay JK , Khoo ML , Loh WS . Surgical considerations for tracheostomy during the COVID-19 pandemic: lessons learned from the severe acute respiratory syndrome outbreak [published online March 31, 2020]. JAMA Otolaryngol Head Neck Surg. 2020. doi:10.1001/jamaoto.2020.0764 PubMed Google Scholar

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.