COVER-ME-UP PROTOCOL: Criteria for pulse MTP immediately after the viraemic phase or early pulmonary phase

Patients have a diagnosis of COVID-19 (I) and concomitant evidence of Cytokine Storm Syndrome (II) AND PREFERENTIALLY WITH PaO₂/FiO₂ > 200.

I—COVID-19 Diagnosis:

A) RT-PCR-SARS-COV-2 positive or

B) Consider the evaluation of the IgM class with the presence or not of IgG, associated with the clinical and tomographic image compatible with COVID-19, and negative RT-PCR-Sars-CoV-2 exam: Keep the note on the CT OR

C) high clinical probability (desaturation below 90% in arterial blood gases, excluding other causes) in the presence of negative A and B

D) CT image result compatible with CORADS 3, 4 OR 5.

II—Definition of Cytokine Storm Syndrome:

A) Patient with oxygen saturation (Sat O2) < 94% at rest (with O₂ catheter at maximum 6 L/min flow) OR with blood oxygen saturation < 90% by the oximeter.

OR

B) Mild tachypnoea—respiratory rate > 18 bpm (although the definition used RR > 30, for inclusion, we need that the patient is in good clinical condition and not deteriorated in case of a respiratory rate greater than or equal to 30).

AND

C) Have two altered BIOMARKERS: C-reactive protein greater than 10, ferritin and d-dimer with or without leucocytosis, preferably IL-6 if available.

However, consider PCR < 10 avoiding the cytokine storm.