COVID-19 and Pneumothorax: A Multicentre Retrospective Case Series

Martinelli, Anthony W.; Ingle, Tejas; Newman, Joseph; Nadeem, Iftikhar; Jackson, Karl; Lane, Nicholas D.; Melhorn, James; Davies, Helen E.; Rostron, Anthony J.; Adeni, Aldrin; Conroy, Kevin; Woznitza, Nicholas; Matson, Matthew; Brill, Simon E.; Murray, James; Shah, Amar; Naran, Revati; Hare, Samanjit S.; Collas, Oliver; Bigham, Sarah; Spiro, Michael; Huang, Margaret M.; Iqbal, Beenish; Trenfield, Sarah; Ledot, Stephane; Desai, Sujal; Standing, Lewis; Babar, Judith; Mahroof, Razeen; Smith, Ian; Lee, Kai; Tchrakian, Nairi; Uys, Stephanie; Ricketts, William; Patel, Anant R.C.; Aujayeb, Avinash; Kokosi, Maria; Wilkinson, Alexander J.K.; Marciniak, Stefan J.

INTRODUCTION: Pneumothorax and pneumomediastinum have both been noted to complicate cases of COVID-19 requiring hospital admission. We report the largest case series yet described of patients with both these pathologies that includes non-ventilated patients. METHODS: Cases were collected retrospectively from UK hospitals with inclusion criteria limited to a diagnosis of COVID-19 and the presence of either pneumothorax or pneumomediastinum. Patients included in the study presented between March and June 2020. Details obtained from the medical record included demographics, radiology, laboratory investigations, clinical management and survival. RESULTS: Seventy-one patients from 16 centres were included in the study, of whom 60 patients had pneumothoraces (six also with pneumomediastinum), whilst 11 patients had pneumomediastinum alone. Two of these patients had two distinct episodes of pneumothorax, occurring bilaterally in sequential fashion, bringing the total number of pneumothoraces included to 62. Clinical scenarios included patients who had presented to hospital with pneumothorax, patients who had developed pneumothorax or pneumomediastinum during their inpatient admission with COVID-19 and patients who developed their complication whilst intubated and ventilated, either with or without concurrent extracorporeal membrane oxygenation. Survival at 28 days was not significantly different following pneumothorax (63.1%±6.5%) or isolated pneumomediastinum (53.0%±18.7%; p=0.854). The incidence of pneumothorax was higher in males. The 28-day survival was not different between the sexes (males 62.5%±7.7% versus females 68.4%±10.7%; p=0.619). Patients above the age of 70 had a significantly lower 28-day survival than younger individuals (≥70 years 41.7%±13.5% survival versus <70 years 70.9%±6.8% survival; p=0.018 log-rank). CONCLUSION: These cases suggest that pneumothorax is a complication of COVID-19. Pneumothorax does not seem to be an independent marker of poor prognosis and we encourage active treatment to be continued where clinically possible.