Background
The SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2) which causes COVID-19 infection (coronavirus disease 2019) has dramatically changed the way that physicians approach airway procedures. SARS-CoV-2 affects multiple levels of the aerodigestive tract. Viral loads in the lower respiratory tract samples (sputum) appear to be significantly higher compared to those from nasal or throat swabs1. Although the exact route of transmission is not well defined, SARS-CoV-2 is thought to be spread via a combination of contact, droplet, and airborne routes2. The Centers for Disease Control and Prevention has recommended use of personal protective equipment for both patients and healthcare personnel in order to decrease risk of transmission; this entails that patients use facemasks and providers utilize isolation gowns, gloves, N95 respirators, and face shields or goggles3. Commonly performed airway procedures including intubation, direct laryngoscopy, bronchoscopy, and tracheostomy placement have a high risk of aerosol generation. Airway providers have reflected on ways to mitigate the transmission risks especially when approaching a surgical airway. Several academic organizations have outlined new recommendations for tracheostomy placement in the setting of the COVID-19 pandemic4-7. To standardize institutional safety measures with tracheostomy, we advocate using a dedicated tracheostomy time-out applicable to all patients including those suspected of having COVID-19 (Figure 1). The aim of this specific tracheostomy time-out is to reduce preventable errors that may increase the risk of transmission of SARS-CoV-2 .