Case series of nebulizing r‐tPA for COVID‐19 induced acute respiratory distress syndrome

Fibrin deposition in the alveolar spaces during pulmonary involvement of COVID‐19 impairs the O2/CO2 exchange and leads to respiratory symptoms. In this report, Recombinant Tissue Plasminogen Activator (r‐tPA) has been nebulized to 3 critically ill COVID‐19 patients in order to resolve the deposited fibrin while avoiding the risk of bleeding. Based on these observations, nebulization of r‐tPA may be a potential therapeutic approach and new area of research for future studies. Fibrin cast depositions play an important role in COVID‐19‐induced ARDS. Systemic administration of fibrinolytic may accompany with risk of bleeding. Nebulization of r‐tPA (Recombinant Tissue Plasminogen Activator) can temporally associated with transient improvements in oxygenation in COVID‐19‐induced ARDS. Fibrinolytic nebulization would minimize bleeding risk‐associated systemic administration.