Pathological findings in critically-ill patients who died from SARS-CoV-2 related acute respiratory distress syndrome – HISTOCOVID

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARScov2) is a new coronavirus discovered in December 2019 in Wuhan, China and currently responsible of a worldwide outbreak and the death of more than 25,000 patients in France. The more severe form of COVID-19 disease induces a pneumonia with profound hypoxemia which may require invasive mechanical ventilation. It is estimated that 5% of COVID-19 patients are admitted to the Intensive Care Unit (ICU) for management. Hospital mortality in patients who develop severe acute respiratory distress syndrome (ARDS) ranges between 40% and 60%. The exact pathophysiology of the disease and the lesions of the lungs are poorly understood and characterised. Indeed, pathological data of SARScov2-induced ARDS are very limited. A better knowledge of the cause death by SARScov2-induced acute respiratory failure is fundamental to guide clinicians in the management of critically-ill COVID-19 patients and help developing new therapeutic strategies. Our purpose is to investigate the pathological findings of COVID-19 patients who died from ARDS in the ICU by doing post-mortem lung biopsies.
Forty-six French ICUs participate to this study with the aim to perform 200 lung biopsies in 100 patients over a 12-month period. This cohort will be the largest pathological database of COVID-19 patients who developed ARDS. In accordance with the French law, this study has been approved and registered by the French Agency of Biomedicine and the French Ministry of Education and Research (#PFS 20-016). Two transcutaneous lung biopsies per patient will be performed using a 14G needle and anatomical landmarks (1 anterior biopsy and 1 posterior biopsy). All biopsies will be referred to the Department of Pathology of Nantes university hospital and analysed by two pathologists specialized in lung tissue. The primary objective is to describe and characterize the lesions of the lung induced by the SARScov2 infection. The secondary objectives are to correlate the pathological findings with the patients’ demographics, the treatments administered during the ICU stay, the ventilator settings, to document the percentage of co-infections and their types, compare the radiographic findings (Chest X-ray and CT-scan of the chest) with the pathological findings, to compare the pathological findings of early deaths (<1week after ICU admission) versus late deaths (>1 week). These pathological findings will undoubtedly help to better understand the pathophysiology of SARScov2 pneumonia and pave the way to the development of new therapeutic strategies.