Minimally Invasive Autopsy: a more feasible and safer alternative to conventional autopsy in the COVID-19 pandemic era?

Rakislova, Natalia; Ismail, Mamudo R.; Martínez, Antonio Claret García; Carrilho, Carla; Martínez, Miguel J.; Bassat, Quique; Ordï, Jaume; Menéndez, Clara

doi:10.33425/2690-5191.1026

Cited by 5 publications

(5 citation statements)

References 34 publications

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“…These requirements are difficult to meet during the current pandemic [ 11 ], especially in low-resource settings. Thus, there is a need for an alternative, less invasive, and theoretically safer approach to conduct post-mortem examinations safely in these settings [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Autopsy Practice in COVID-19 Cases: Biosafety and Findings

et al. 2021

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Postmortem studies are crucial for providing insight into emergent diseases. However, a complete autopsy is frequently not feasible in highly transmissible diseases due to biohazard challenges. Minimally invasive autopsy (MIA) is a needle-based approach aimed at collecting samples of key organs without opening the body, which may be a valid alternative in these cases. We aimed to: a) provide biosafety guidelines for conducting MIAs in COVID-19 cases, b) compare the performance of MIA versus complete autopsy, and c) evaluate the safety of the procedure. Between October and December 2020, MIAs were conducted in six deceased patients with PCR-confirmed COVID-19, in a basic autopsy room, with reinforced personal protective equipment. Samples from the lungs and key organs were successfully obtained in all cases. A complete autopsy was performed on the same body immediately after the MIA. The diagnoses of the MIA matched those of the complete autopsy. In four patients, COVID-19 was the main cause of death, being responsible for the different stages of diffuse alveolar damage. No COVID-19 infection was detected in the personnel performing the MIAs or complete autopsies. In conclusion, MIA might be a feasible, adequate and safe alternative for cause of death investigation in COVID-19 cases.

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Section: Introductionmentioning

confidence: 99%

Minimally Invasive Autopsy Practice in COVID-19 Cases: Biosafety and Findings

et al. 2021

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“…Minimally invasive autopsy (MIA) is a validated tool to establish the cause of death, that has been studied mainly in resource-limited settings [ 1 ]. One of the advantages of MIA is its limited risk of disease transmission making it an ideal tool in the current coronavirus disease 2019 (COVID-19) pandemic [ 2 , 3 ]. However, if it increases clinical knowledge in COVID-19 patients in high-resource settings remains unknown.…”

Section: Introductionmentioning

confidence: 99%

The clinical value of minimal invasive autopsy in COVID-19 patients

et al. 2020

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Background Minimally invasive autopsy (MIA) is a validated and safe method to establish the cause of death (COD), mainly in low-resource settings. However, the additional clinical value of MIA in Coronavirus disease (COVID-19) patients in a high-resource setting is unknown. The objective was to assess if and how MIA changed clinical COD and contributing diagnoses in deceased COVID-19 patients. Methods and findings A prospective observational cohort from April to May 2020 in a 981-bed teaching hospital in the epicenter of the COVID-19 pandemic in Belgium was established. Patients who died with either PCR-confirmed or radiologically confirmed COVID-19 infection were consecutively included. MIA consisted of whole-body CT and CT-guided Tru-Cut® biopsies. Diagnostic modalities were clinical chart review, radiology, microbiology, and histopathology which were assessed by two independent experts per modality. MIA COD and contributing diagnoses were established during a multi-disciplinary meeting. Clinical COD (CCOD) and contributing diagnosis were abstracted from the discharge letter. The main outcomes were alterations in CCOD and contributing diagnoses after MIA, and the contribution of each diagnostic modality. We included 18 patients, of which 7 after intensive care unit hospitalization. MIA led to an alteration in 15/18 (83%) patients. The CCOD was altered in 5/18 (28%) patients. MIA found a new COD (1/5), a more specific COD (1/5), a less certain COD (1/5), or a contributing diagnosis to be the COD (2/5). Contributing diagnoses were altered in 14/18 (78%) patients: 9 new diagnoses, 5 diagnoses dismissed, 3 made more specific, and 2 made less certain. Overall, histopathology contributed in 14/15 (93%) patients with alterations, radiology and microbiology each in 6/15 (40%), and clinical review in 3/15 (20%). Histopathology was deemed the most important modality in 10 patients, radiology in two patients, and microbiology in one patient. Conclusion MIA, especially histological examination, can add valuable new clinical information regarding the cause of death in COVID-19 patients, even in a high-resource setting with wide access to premortem diagnostic modalities. MIA may provide important clinical insights and should be applied in the current ongoing pandemic. Trial registration Clinicaltrials.gov identifier: NCT04366882

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“…13 Another aspect to be mentioned about the issue was the emergence of the COVID-19 pandemic, which led most services to suspend autopsies for safety reasons. [14][15][16] The objective of autopsies is to obtain more information about the pathological processes and determine the factors contributing to death. 17 If, on the one hand, this practice has become increasingly difficult in cases in which the family does not allow it to be performed, 11 on the other hand minimally invasive autopsy (MIA) has become an increasingly used method for collecting samples from key post-mortem organs.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of minimally invasive autopsy in the diagnosis of arboviruses to increase the sensitivity of the Epidemiological Surveillance System in Ceará, Brazil

Almeida,

Melo,

Silva

et al. 2024

Epidemiol. Serv. Saúde

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Objective: To create a protocol for performing minimally invasive autopsies (MIA) in detecting deaths from arboviruses and report preliminary data from its application in Ceará state, Brazil. Methods: Training was provided to medical pathologists on MIA. Results: A protocol was established for performing MIA, defining criteria for sample collection, storage methods, and diagnoses to be carried out according to the type of biological sample; 43 MIAs were performed in three months. Of these, 21 (48.8%) arrived at the Death Verification Service (SVO) with arboviruses as a diagnostic hypothesis, and seven (16.3%) were confirmed (six chikungunya cases and one dengue case); cases of COVID-19 (n = 9), tuberculosis (n = 5), meningitis (n = 4), cryptococcosis (n = 1), Creutzfeldt-Jakob disease (n = 1), breast cancer (n = 1), and human rabies (n = 1) were also confirmed. Conclusion: The protocol implemented enabled identification of a larger number of suspected arbovirus-related deaths, as well as confirmation of other diseases of interest for surveillance.

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Minimally Invasive Autopsy: a more feasible and safer alternative to conventional autopsy in the COVID-19 pandemic era?

Cited by 5 publications

References 34 publications

Minimally Invasive Autopsy Practice in COVID-19 Cases: Biosafety and Findings

Minimally Invasive Autopsy Practice in COVID-19 Cases: Biosafety and Findings

The clinical value of minimal invasive autopsy in COVID-19 patients

Usefulness of minimally invasive autopsy in the diagnosis of arboviruses to increase the sensitivity of the Epidemiological Surveillance System in Ceará, Brazil

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