Abstract
New options for treatment escalation in critically ill COVID-19 patients are unmet need. Five critically ill patients were treated using a low-dose protocol thrombolytic therapy in the form of intravenous alteplase infusion over 15 min (0.6 mg/kg). This therapeutic intervention yielded an immediate favorable outcome on follow up and all five patients were extubated and transferred to the ward. This report suggests that bedside echocardiography can be a beneficial tool in the urgent assessment of the right ventricle-to-pulmonary vascular coupling in mechanically ventilated COVID-19 patients, and thrombolytic therapy may be beneficial in hemodynamically unstable patients who show echocardiographic criteria of right ventricular strain.