Trial eligibility according to PICO
| Inclusion | Exclusion | |
| Population | Adult hospitalised patients with laboratory confirmed (PCR) COVID-19 infection and ARDS according to the Berlin criteria | Children, ARDS caused by non-SARS-COV-2 infection |
| Intervention | Fibrinolytic therapy (eg, alteplase, tenecteplase) on top of standard of care | Fibrinolytic therapy with other indication (eg, stroke) |
| Comparator | Standard of care alone | |
| Primary outcomes | Change in PaO2/FiO2 ratio (Horrowitz index) pre-to-post intervention, ventilation-free days; time to ventilator-free state, successful extubation and mortality | |
| Safety outcomes | Bleeding event rate (major bleeding, clinically relevant non-major bleeding and minor bleeding as per ISTH); requirement for transfusion (packed red blood cell, platelet, fresh frozen plasma, cryoprecipitate, prothrombin complex concentrate) | |
| Study design | Randomised clinical trials, prospective observational trials | Retrospective trials, case series, case reports, animal studies, conference abstracts |
ARDS, acute respiratory distress syndrome; ISTH, International Society on Thrombosis and Haemostasis; PaO2/FiO2 ratio, ratio of arterial oxygen partial pressure to fractional inspired oxygen.