Salvage use of tissue plasminogen activator (tPA) in the setting of acute respiratory distress syndrome (ARDS) due to COVID-19 in the USA: a Markov decision analysis.
Betacoronavirus
COVID-19
Coronavirus Infections
/ drug therapy
Critical Illness
Decision Support Techniques
Humans
Markov Chains
Pandemics
Pneumonia, Viral
/ drug therapy
Respiratory Distress Syndrome
/ drug therapy
SARS-CoV-2
Salvage Therapy
Survival Rate
Tissue Plasminogen Activator
/ therapeutic use
United States
COVID-19 Drug Treatment
Acute respiratory distress syndrome (ARDS)
COVID-19
Fibrinolysis
Markov
Pulmonary failure
Tissue plasminogen activator (tPA)
Journal
World journal of emergency surgery : WJES
ISSN: 1749-7922
Titre abrégé: World J Emerg Surg
Pays: England
ID NLM: 101266603
Informations de publication
Date de publication:
20 04 2020
20 04 2020
Historique:
received:
25
03
2020
accepted:
30
03
2020
entrez:
22
4
2020
pubmed:
22
4
2020
medline:
24
4
2020
Statut:
epublish
Résumé
COVID-19 threatens to quickly overwhelm our existing critical care infrastructure in the USA. Systemic tissue plasminogen activator (tPA) has been previously demonstrated to improve PaO A decision analytic Markov state transition model was created to simulate the life critically ill COVID-19 patients as they transitioned to either recovery or death. Two patient groups were simulated (50,000 patients in each group); (1) Patients received tPA immediately upon diagnosis of ARDS and (2) patients received standard therapy for ARDS. Base case critically ill COVID-19 patients were defined as having a refractory PaO The use of tPA was associated with reduced mortality (47.6% [tTPA] vs. 71.0% [no tPA]) for base case patients. When extrapolated to the projected COVID-19 eligible for salvage use tPA in the USA, peak mortality (deaths/100,000 patients) was reduced for both optimal social distancing (70.5 [tPA] vs. 75.0 [no tPA]) and no social distancing (158.7 [tPA] vs. 168.8 [no tPA]) scenarios. Salvage use of tPA may improve recovery of ARDS patients, thereby reducing COVID-19-related mortality and ensuring sufficient resources to manage this pandemic.
Sections du résumé
BACKGROUND
COVID-19 threatens to quickly overwhelm our existing critical care infrastructure in the USA. Systemic tissue plasminogen activator (tPA) has been previously demonstrated to improve PaO
METHODS
A decision analytic Markov state transition model was created to simulate the life critically ill COVID-19 patients as they transitioned to either recovery or death. Two patient groups were simulated (50,000 patients in each group); (1) Patients received tPA immediately upon diagnosis of ARDS and (2) patients received standard therapy for ARDS. Base case critically ill COVID-19 patients were defined as having a refractory PaO
RESULTS
The use of tPA was associated with reduced mortality (47.6% [tTPA] vs. 71.0% [no tPA]) for base case patients. When extrapolated to the projected COVID-19 eligible for salvage use tPA in the USA, peak mortality (deaths/100,000 patients) was reduced for both optimal social distancing (70.5 [tPA] vs. 75.0 [no tPA]) and no social distancing (158.7 [tPA] vs. 168.8 [no tPA]) scenarios.
CONCLUSIONS
Salvage use of tPA may improve recovery of ARDS patients, thereby reducing COVID-19-related mortality and ensuring sufficient resources to manage this pandemic.
Identifiants
pubmed: 32312290
doi: 10.1186/s13017-020-00305-4
pii: 10.1186/s13017-020-00305-4
pmc: PMC7169373
doi:
Substances chimiques
Tissue Plasminogen Activator
EC 3.4.21.68
Types de publication
Letter
Langues
eng
Sous-ensembles de citation
IM
Pagination
29Subventions
Organisme : NIGMS NIH HHS
ID : F32-HL134244
Pays : United States
Organisme : NHLBI NIH HHS
ID : F32 HL134244
Pays : United States
Organisme : NHLBI NIH HHS
ID : UM1 HL120877
Pays : United States
Organisme : National Institutes of Health (US)
ID : UM1-HL120877
Pays : International
Organisme : NHLBI NIH HHS
ID : UM1-HL120877
Pays : United States
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