This is a review of tracheostomies completed by an OMFS Unit in London from 10 March to 18 May 2020. A total of 176 COVID-19 patients were admitted to intensive care, 72 of which required tracheostomy due to prolonged respiratory weaning and/or failed extubation. Of these, 44 were open and 28 percutaneous. At least two major comorbidities were present in 65% of the patients. The median time to tracheostomy was 17 days. The minimum follow-up was 14 days and median follow-up, 26 days. Mortality rate was 9.7%, all deaths being related to COVID-19 complications. It was anticipated those patients undergoing open tracheostomy had a significantly higher BMI. Other influencing factors of open or percutaneous tracheotomies included exhaustion of the percutaneous kits both locally and within the national supply chain. A tendency to require a larger tube than expected was also noted. The trachea was often dilated and inflamed at the time of the procedure. This brought challenges further on as patients appeared to experience more cuff leaks and required downsizing as part of the weaning process. No team members developed COVID-19 symptoms.