Head and Neck Academic Centre

When COVID-19 leads to a severe infection in the lungs, patients need to be placed on a ventilator. Before the pandemic, clinical practice was for patients expected to be on a ventilator for over 7 days to undergo a tracheostomy, a surgical procedure to put a breathing tube through the neck into the airway. It is uncertain whether patients with COVID-19 also benefit from this operation due to the severity of their respiratory illness and high death rate. Furthermore, there is concern that opening the airway through the tracheostomy puts healthcare professionals performing the procedure at risk of being infected by the coronavirus.

COVIDTrach is a collaborative project by surgeons and intensive care doctors that looks at the outcomes of ventilated COVID-19 patients undergoing tracheostomy and evaluates the use of personal protective equipment and the rate of COVID-19 infection amongst operators. So far, data on 800 patients have been entered into an online database; this proposal focuses on expanding and completing this database to answer the fundamental questions of the safety and effectiveness of tracheostomy in COVID-19.

• UCL Rapid Response COVID-19 Fund / Wellcome Trust
• NIHR Clinical Research Network
• The Federation of Surgical Specialty Associations
• Intensive Care Society
• Difficult Airway Society

• Aberdeen Royal Infirmary
• Addebrooke's Hospital
• Aintree University Hospitals NHS Trust
• Ashford St Peter's
• Barking, Havering and Redbridge NHS Trust
• Barnet Hospital
• Basingstoke & North Hampshire Hospital
• Bedford Hospitals NHS Foundation Trust
• Birmingham Queen Elizabeth Hospital
• Birmingham City Hospital
• Birmingham Heartlands & Goodhope Hospital
• Bodelwyddan - Glan Clwyd Hospital
• Bradford Royal Infirmary
• Bristol Royal Infirmary
• Broomfield Hospital
• Chelsea & Westminister
• Colchester Hospital
• Conquest Hospital
• Countess of Chester Hospital
• Coventry and Warwickshire Hospital
• Croydon Hospital
• Doncaster Royal Hospital
• Dumfries and Galloway
• East Surrey Hospital
• Eastbourne District General Hospital
• Forth Valley Royal Hospital
• Glasgow Royal Infirmary
• Gloucestershire Hospitals NHS Trust
• Great Western Hospital
• GSTT
• Harefield Hospital
• Hereford Country Hospital
• Hillingdon Hospital
• Homerton University Hospital
• Imperial NHS Trust
• Inverclyde Royal Infirmary
• Isle of Wight
• James Paget Hospital
• John Radcliffe
• Kent and Canterbury
• King's College Hospital
• Kings Mill Hospital
• Leeds General Infirmary
• Leicester Royal Infirmary
• Lewisham Hospital
• Lister Hospital
• Maidstone and Tunbridge Wells NHS Trust
• Manchester University Foundation Trust
• Medway Maritime Hospital
• Monklands General Hospital
• Morriston
• Musgrove Park Hospital
• Nevill Hall Hospital
• New Cross Hospital
• Newcastle Hospital
• Norfolk and Norwich University Hospital
• North Cumbria Integrated Care
• Northumbria Healthcare NHS Trust
• Northwick Park Hospital
• Peterborough City Hospital
• Pinderfields Hospital
• Prince Charles Hospital Merthyr Tydfil
• Princess Alexandra Hospital
• Queens Alexandra Hospital
• Queen Elizabeth University Hospital
• Queens Medical Centre
• Queen's Hospital (Burton)
• Raigmore Hospital, Inverness
• Royal Albert Edward Hospital
• Royal Alexandra Hospital
• Royal Berkshire NHS Foundation Trust
• Royal Blackburn Hospital
• Royal Bolton Hospital
• Royal Cornwall Hospital
• Royal Derby Hospital
• Royal Free Hospital
• Royal Gwent Hospital
• Royal Liverpool Hospital
• Royal London Hospital (Barts Health)
• Royal Preston Hospital
• Royal Sussex County Hospital
• Russells Hall
• Salisbury District Hospital
• Scarborough Hospital
• Sheffield Teaching Hospital
• Shrewsbury and Telford Hospitals
• Southend University Hospital
• St Georges Hospital
• St Helens & Knowsley Teaching Hospitals NHS Trust
• St John's Hospital at Howden
• Stepping Hill Hospital
• Stoke Mandeville Hospital
• Sunderland Royal Hospital
• Tameside & Glossop Integrated Care NHS Trust
• The James Cook University Hospital
• The Rotherham NHS Foundation Trust
• The Whittington Hospital
• Tunbridge Wells Hospital
• University College London Hospitals
• University Hospital of North Midlands
• University Hospital of Wales
• University Hospital Southampton
• University Hospitals Bristol and Weston NHS Foundation Trust
• University Hospitals Derby & Burton
• University Hospitals Plymouth
• Walsall Manor Hospital
• Watford General Hospital
• West Middlesex Hospital
• West Suffolk Hospital
• Wexham Park Hospital
• Whipps Cross University Hospital (Barts Health)
• Whittington Hospital
• William Harvey Hospital
• Wrexham Maelor Hospital
• Wythenshawe Hospital
• York Hospital

Preprint report: COVIDTrach collaborative, NJI Hamilton, et al., COVIDTrach; a prospective cohort study of mechanically ventilated COVID-19 patients undergoing tracheostomy in the UK. (2020). medRxiv 2020.10.20.20216085.

Interim Report: COVIDTrach; the outcomes of mechanically ventilated COVID-19 patients undergoing tracheostomy in the UK. (2020). BJS. 107 (12), e583-e584.

Cancer at the back of the mouth and throat is usually only discovered after it has spread to lymph glands in the neck. This means that both the original tumour and the cancer that has spread need to be treated.

Doctors need to decide whether to treat just one side of the neck or to treat both, as the cancer may have spread to both sides or may be likely to spread to another side in the future. They base this decision on things such as how aggressive the cancer is, whether the patient smokes and whether the HPV virus is present. This difficult decision can mean some patients get treatment on both sides of the neck that they may not need, which can result in lasting problems with swallowing. Others can receive treatment on one side only to have the cancer return on the other.

This study hopes to give doctors more accurate information on whether to treat one side or two. This will be done using a procedure called Sentinel Node Biopsy (SNB) to see whether the cancer has spread to the other side of the neck. If this study is successful, we will have found a way to give doctors much better, more accurate information on what treatment to give and speed up the time that it takes for patients to go through the treatment process.

• UCL
• NIHR Clinical Research Network

Patients must meet the following two criteria:

• Undergoing any type of surgery in an operating theatre, including obstetrics.
• Either before or after surgery: (i) lab test confirmed SARS-CoV2 infection or (ii) clinical diagnosis of COVID-19 (no test performed).

Any hospital can participate. Some hospitals might currently have few cases while others might have a lot. Every hospital treating or expecting to treat surgical patients with COVID-19 infection is welcome.

The primary outcome is mortality at 30 days after surgery. Secondary outcomes will be other surgical and medical complications. There is no fixed data collection period and patients can be included either prospectively or retrospectively. Data will be stored in a secure online platform (REDCap). Only anonymised data will be collected.

All the collaborators will be recognised as co-authors in any publications resulting from this study. A corporate authorship model will be used under the CovidSurg Collaborative group.

• NIHR Global Health Research Unit