The starfish story and lung transplantation for COVID-19
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CORRESPONDENCE
The starfish story and lung transplantation for COVID-19 Dhruva Sharma 1
&
Ganapathy Subramaniam 2
Received: 14 October 2020 / Revised: 30 October 2020 / Accepted: 3 November 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
To The Editor: There is a famous parable: “The story of the boy and the starfish” One day a man walking along the beach notices a boy picking something carefully and throwing it gently back into the ocean. Approaching the boy, the man asks what he was doing. The boy replies: “throwing starfish back into the ocean”. The surf is up and the tide is going out. If I do not throw them back, they’ll die. The man said: “Son, don’t you realize there are miles and miles of beach and hundreds of starfish? You can’t make a difference!” Till mid of October 2020, the coronavirus disease (COVID19) had killed more than 100,000 patients in India. The world estimates were approximately 10 times this number and the number of infected individuals was approximately 40–80 times. Acute respiratory distress syndrome (ARDS) coupled with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection has constituted a challenge in this worldwide pandemic of unrivalled consequence. Despite the majority of patients with COVID-19 presenting with mild or asymptomatic disease, 10% of cases necessitated intensive care unit (ICU) admission owing to the development of ARDS with a mortality rate of up to 60%. Lung transplantation (LT) is considered a rescue therapy for patients with severe, treatment-refractory ARDS. Lung injury is usually present in around 30% of COVID-19 cases. Chest computed tomography (CT) scan dem-
* Dhruva Sharma [email protected] 1
Department of Cardiothoracic and Vascular Surgery, SMS Medical College & Attached Hospitals, J L N Marg, Jaipur, Rajasthan 302001, India
2
Institute of Heart and Lung Transplant and Mechanical Circulatory Support, MGM Healthcare, No. 72, Nelson Manickam Road, Aminjikarai, Chennai 600029 Tamil-Nadu, India
onstrated 97% and 75% sensitivity in diagnosing specimenpositive and specimen-negative patients, respectively, but with only 25% specificity. Of late, it is concluded that ground-glass opacity, with or without consolidation, was most commonly noted among COVID-19 patients. The COVID-19 Reporting and Data System (CO-RADS) grants a level of conjecture for pulmonary involvement of COVID-19, formed on the countenance seen at unenhanced chest CT [1, 2]. In a case report by Lang et al. on LT for COVID-19linked ARDS [1], a 44-year-old woman tested positive for SARS-CoV-2 through nasopharyngeal swab real-time polymerase chain reaction (RT-PCR). Her respiratory condition worsened, requiring femoro-femoral veno-venous extracorporeal membrane oxygenation (ECMO). When not controlled medically, after 48 days, she was considered a possible candidate for LT. On pulmonary CT, there was evidence of complete consolidation of the lungs coupled with large necrotic areas and air inclusions, substantial infarctions of the peripheral parts of
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