pathological findings of fatal covid-19

Conditions: SARS-CoV-2; Covid19; Pathology; Intensive Care Units; Respiratory Distress Syndrome

Summary: the severe acute respiratory syndrome coronavirus 2 (sars-cov-2) is a new coronavirus discovered in december 2019 in wuhan, china and currently responsible of a worldwide outbreak and the death of more than 55,000 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 investigators purpose to investigate the pathological findings of covid-19 patients who died from ards in the icu by doing post-mortem lung biopsies

forty-four 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 a group of pathologists specialized in lung tissue. the primary objective is to describe and characterize the lesions of the lung induced by the sars-cov-2 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 (\ 1 week). these pathological findings will undoubtedly help to better understand the pathophysiology of sars-cov-2 pneumonia and pave the way to the development of new therapeutic strategies

Eligibility criteria:
inclusion criteria: * adult patients (age≥18 years-old) * hospitalized in intensive care unit (icu) * dead in the icu from documented covid-19 (clinical and radiological signs of pneumonia with a positive sars-cov-2 pcr from the upper or lower respiratory tract) * not registered in the national register of refusal of the french biomedicine agency * according to french law, there was no requirement for signed consent, but the patient's next of kin were informed about the study before enrolment and were given a letter of information about the study. exclusion criteria: * covid-19 not documented by a positive sars-cov-2 pcr * patient with a positive sars-cov-2 pcr but without any signs of pneumonia during the icu stay (no clinical and no radiological signs of pneumonia) * patient registered in the "national register of refusal" of the french biomedicine agency * refusal expressed by the patient's next of kin to participate to the study

Keywords: sars-cov-2 pneumonia intensive care units acute respiratory distress syndrome histopathology