• Christopher D Barrett, Achikam Oren-Grinberg, Edward Chao, Andrew H Moraco, Matthew J Martin, Srinivas H Reddy, Annette M Ilg, Rashi Jhunjhunwala, Marco Uribe, Hunter B Moore, Ernest E Moore, Elias N Baedorf-Kassis, Megan L Krajewski, Daniel S Talmor, Shahzad Shaefi, and Michael B Yaffe.
• From the Division of Acute Care Surgery (C.D.B., R.J., M.B.Y.), Trauma and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; Departments of Biological Engineering and Biology (C.D.B., M.B.Y.), Koch Institute for Integrative Cancer Research, Center for Precision Cancer Medicine, Massachusetts Institute of Technology, Cambridge; Department of Anesthesia (A.O.-G., A.M.I., M.L.K., D.S.T., S.S.), Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Division of Trauma and Surgical Critical Care (E.C., S.H.R., M.U.), Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York; Division of Pulmonary and Critical Care (A.H.M.), Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts; Department of Surgery (M.J.M.), Scripps Mercy Hospital, San Diego, California; Department of Emergency Medicine (A.M.I.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Department of Surgery (H.B.M., E.E.M.), University of Colorado Denver, Aurora; Department of Surgery (E.E.M.), Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado; Division of Pulmonary, Critical Care and Sleep Medicine (E.N.B.-K.), Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
• J Trauma Acute Care Surg. 2020 Sep 1; 89 (3): 453-457.

AbstractThe coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented stresses on modern medical systems, overwhelming the resource infrastructure in numerous countries while presenting a unique series of pathophysiologic clinical findings. Thrombotic coagulopathy is common in critically ill patients suffering from COVID-19, with associated high rates of respiratory failure requiring prolonged periods of mechanical ventilation. Here, we report a case series of five patients suffering from profound, medically refractory COVID-19-associated respiratory failure who were treated with fibrinolytic therapy using tissue plasminogen activator (tPA; alteplase). All five patients appeared to have an improved respiratory status following tPA administration: one patient had an initial marked improvement that partially regressed after several hours, one patient had transient improvements that were not sustained, and three patients had sustained clinical improvements following tPA administration. LEVEL OF EVIDENCE: Therapeutic, Level V.

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