In Situ Pulmonary Thrombolysis and Perfusion Lung Angiography in Severe COVID-19 Respiratory Failure

Autor: Angel Augusto Pérez-Calatayud, MD, Rocío Enriquez-García, MD, MS, Christian Fareli-González, MD, PhD, Christopher D. Barrett, MD, Carlos Alberto Saldivar-Rodea, MD, Jorge Perulles-Marin, MD, Miguel Angel Reyes-Caldelas, MD, Carlos Ivan Rosenberg-Contreras, MD, Julieta Berenice Gómez-Moreno, MD, Guadalupe Guerrero-Avendaño, MD, Raúl Serrano-Loyola, MD, Raúl Carrillo-Esper, MD, Ernest E. Moore, MD
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Critical Care Explorations, Vol 4, Iss 4, p e0670 (2022)
Druh dokumentu: article
ISSN: 2639-8028
00000000
DOI: 10.1097/CCE.0000000000000670
Popis: OBJECTIVES:. A proof-of-concept study using thrombolysis with catheter-directed tissue plasminogen activator (tPA) and pulmonary angiography imaging was performed to visualize perfusion deficits and reperfusion/therapeutic effects of tPA. DESIGN:. A prospective, open-label, compassionate study. Descriptive statistics were presented for categorical variables and as means with sds for continuous variables. The Wilcoxon test was used to determine the differences between the two-related samples and a t test for continuous variables. Statistical significance was set at p value of less than 0.05. Agreement between observations was evaluated using the Kappa Cohen index and overall agreement using the Fleiss Kappa coefficient. SETTING:. A single COVID-19 ICU of Mexico´s General Hospital Dr Eduardo Liceaga. SUBJECTS:. Fifteen patients with severe Delta variant severe acute respiratory syndrome coronavirus 2 infection, 18–75 years old, requiring mechanical ventilation with a persistent Fio2 requirement of 70% or higher and Pao2/Fio2 ratio (or imputed ratio) less than 150 for more than 4 hours. The coagulation inclusion criteria were International Society on Thrombosis and Haemostasis score greater than 5, and presence of a d-dimer greater than 1,200, with viscoelastic testing using rotational thromboelastometry (Instrumentation Laboratories, Mexico City, Mexico) showing both hypercoagulability (EXTEM amplitude at 5 min > 65 FIBTEM > 30) and hypofibrinolysis (EXTEM maximum lysis < 8%). INTERVENTIONS:. Catheter-directed tPA angiography and iFlow system analysis to assess pre-tPA baseline pulmonary perfusion and changes in response to thrombolysis. RESULTS:. Nine patients had microvascular filling defects demonstrated by angiography, and good agreement was found with iFlow analysis (ƙ = 0.714). Statistically significant differences were identified in the area under the curve (AUC) region of interest/AUC reference tissue with and without filling defects in phase 2 DM –0.09206 (sd ± 0.16684) (p = 0.003). The Pao2/Fio2 values measured immediately and 48 hours after the procedure were significantly higher (p = 0.001 and p = 0.005, respectively). Statistically significant differences were found in d-dimer values (p = 0.007), Fio2 (p = 0.002), and oxygen saturation in arterial blood/Fio2 (p = 0.045), as well as in the number of patients who required prone positioning before, immediately after the procedure, and at 48 hours after the procedure (p = 0.002). CONCLUSIONS:. Thrombolysis with catheter-directed tPA resulted in imaging evidence via pulmonary angiography and iFlow technology of improved lung perfusion in COVID-19 patients with severe respiratory failure.
Databáze: Directory of Open Access Journals
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