Spontaneous Pneumomediastinum in COVID-19: The Macklin Effect?

Sekhon et al examines the case of three healthy adult males who presented with spontaneous pneumomediastinum from coronavirus disease (COVID-19) before the institution of positive pressure ventilation. Chest computed tomography confirmed pneumomediastinum and air tracking along the pulmonary vasculature. Each patient underwent venovenous extracorporeal membrane oxygenation (VV-ECMO) for optimal lung-protective ventilation to mitigate exacerbation of pneumomediastinum from mechanical ventilation after clinical deterioration. Patients B and C have been liberated from VV-ECMO and discharged, whereas patient A remains on VV-ECMO.