Nebulised Heparin to Reduce COVID-19 Induced Acute Lung Injury

Inclusion criteria

To be eligible, a patient must satisfy all these inclusion criteria:

• Confirmed or suspected COVID-19. Note, if 'suspected', results must be pending or testing intended
• Ability to obtain informed consent/assent to participate in study
• Age 18 years or older
• Requiring high flow nasal oxygen or positive pressure ventilator support or invasive mechanical ventilation for a time period of no greater than 48 hours
• D-dimers > 200 ng/ml
• PaO2 to FIO2 ratio less than or equal to 300
• Acute opacities on chest imaging affecting at least one lung quadrant. Note 'Acute opacities' do not include effusions, lobar/lung collapse or nodules
• Currently in a higher level of care area designated for inpatient care of patients where therapies including non-positive pressure ventilatory support can be provided.

Exclusion criteria

To be eligible, a patient must have none of these exclusion criteria:

• Enrolled in another clinical trial that is unapproved for co-enrolment
• Heparin allergy or heparin-induced thrombocytopaenia
• APTT > 100 seconds
• Platelet count < 50 x 109 per L
• Pulmonary bleeding, which is frank bleeding in the trachea, bronchi or lungs with repeated haemoptysis or requiring repeated suctioning
• Uncontrolled bleeding
• Pregnant or suspected pregnancy (Urine or serum HCG will be recorded)
• Receiving or about to commence ECMO or HFOV
• Myopathy, spinal cord injury, or nerve injury or disease with a likely prolonged incapacity to breathe independently e.g. Guillain-Barre syndrome
• Usually receives home oxygen
• Dependent on others for personal care due to physical or cognitive decline (pre-morbid status)
• Death is imminent or inevitable within 24 hours
• The clinical team would not be able to set up the study nebuliser and ventilator circuit as required including with active humidification
• Clinician objection.
• The use or anticipated use of nebulised tobramycin during this clinical episode
• Any other specific contraindication to anticoagulation including prophylactic anticoagulation not otherwise listed here
• Relapse in clinical condition in patient that had fully weaned from advanced respiratory support
• Any systemic anticoagulation other than prophylactic anticoagulation