Venovenous Extracorporeal Membrane Oxygenation in Awake Non-Intubated Patients With COVID-19 ARDS at High Risk for Barotrauma

The Macklin effect closely correlates with pneumomediastinum in acutely ill intubated patients with COVID-19 infection

“…If validated as a novel biomarker for pulmonary barotrauma, this may become an important part of critical care algorithms and may have prognostic implications. 20 …”

Macklin effect on baseline chest CT scan accurately predicts barotrauma in COVID-19 patients

“…This might be particularly important in the course of pandemic waves, in settings of limited resources. In addition, our findings could also provide baseline data for the potential development of a therapeutic algorithm for patients thought to be at high-risk for barotrauma development and lung damage progression, identifying those most likely to benefit from various strategies (early application of ultraprotective mechanical ventilation or extracorporeal support) [ [22] , [23] , [24] , [25] ]. However, future studies should investigate whether different management strategies could actually prevent barotrauma development, and whether these will translate in outcome improvement.…”

An increasing rate of pneumomediastinum in non-intubated COVID-19 patients: The role of steroids and a possible radiological predictor

“…Detection of Macklin-like radiological sign on the baseline chest CT scan in patients with respiratory failure may be used to identify patients at high risk for barotrauma and select patients for advanced management strategies, including ultraprotective ventilation [ 19 ] or early use of extracorporeal membrane oxygenation without invasive ventilation [ 20 ]. However, these hypotheses require further investigation.…”