Postmortem Minimally Invasive Autopsy in Critically Ill Covid-19 Patients at the Bedside: A Proof-of-Concept Study at the Icu

Background: Autopsy tissues collected 24-48 h post mortem are characterized by full-blown autolytic phenomena disabling the histological or ultrastructural workup of subtle intravital changes. Moreover, economic restrictions and workforce cuts have continually challenged conventional autopsies. Recently, the COVID-19 pandemic has added requirements for tissue quality and safety to the investigation of this disease, thereby launching efforts to upgrade autopsy strategies.Methods: In this proof-of-concept study, we performed bedside ultrasound-guided minimally invasive autopsies (US-MIA) of patients that had died from critical COVID-19 in the intensive care unit (ICU) using a structured protocol to obtain almost autolytic-free tissue. Biopsies were assessed for quality (vitality and length) and for diagnosis. The efficiency of the procedure was monitored in five cases by recording the time of each step and safety issues by swabbing personal protective equipment and devices for viral contamination. Findings: Ultrasound examination and tissue procurement required a mean of 13 min and 54 min, respectively. A total of 318 multiorgan biopsies were obtained from five patients. Quality and vitality standards were fulfilled and allowed not only specific histopathological diagnosis but also reliable detection of SARS-CoV-2 virions in unexpected organs using electronic microscopy. Interpretation: Bedside multidisciplinary US-MIA allows fast and efficient acquisition of almost autolytic-free tissue and offers unappreciated potential to overcome the limitations of research in postmortem studies. FundingThe study was financially supported by the BMBF (DEFEAT Pandemics, 01KX2121)