Extracorporeal Cytokine Removal in Critically Ill COVID-19 Patients: A Case Series.

Marcell Virág,Ágnes Sárkány,Klementina Ocskay,Tamás Leiner,Alexa Vasquez,Daniel Adam Blanco,László Bucsi,Balázs Horváth,Zsolt Molnár,Máté Rottler

doi:10.3389/fmed.2021.760435

Abstract

Introduction: Extracorporeal hemoadsorption (HA) is a potential adjunctive therapy in severe cases of COVID-19 associated pneumonia. In this retrospective study we report data from critically ill patients treated with HA during the first and second wave of the pandemic.Patients and Methods: All patients, who received HA therapy with CytoSorb within the first 96 h of intensive care unit (ICU) admission without hospital-acquired bacterial superinfection, were included. Clinical and laboratory data were collected: on admission, before (TB) and after (TA) HA therapy.Results: Out of the 367 COVID-19 cases, 13 patients were treated with CytoSorb, also requiring mechanical ventilation and renal replacement therapy. All patients were alive at the end of HA, but only 3 survived hospital stay. From TB-TA there was a tendency of decreasing norepinephrine requirement: 193.7 [IQR: 34.8–270.4] to 50.2 [6.5–243.5] ug/kg/day and increasing PaO2/FiO2 ratio 127.8 (95% CI: 96.0–159.6) to 155.0 (115.3–194.6) mmHg but they did not reach statistical significance (p = 0.14 and 0.58, respectively). Treatment related adverse events were not reported.Conclusion: The treatment was well-tolerated, and there was a tendency toward an improvement in vasopressor need and oxygenation during the course of HA. These observations render the need for prospective randomized trials.

Highlights

Extracorporeal hemoadsorption (HA) is a potential adjunctive therapy in severe cases of COVID-19 associated pneumonia
Out of the 367 patients treated with COVID-19 in the intensive care units (ICUs), invasive ventilation was necessary in 153 cases
Thirty-Seven patients were on continuous renal replacement (CRRT), and 13 patients were included the current case series suffering from COVID-19 viral pneumonia, who received hemoadsorption therapy with CytoSorb

Summary

Introduction

Extracorporeal hemoadsorption (HA) is a potential adjunctive therapy in severe cases of COVID-19 associated pneumonia In this retrospective study we report data from critically ill patients treated with HA during the first and second wave of the pandemic. Due to the early introduction of lockdown during the first wave of the pandemic, Hungary experienced significantly less pressure on its healthcare system compared to most of the Western European countries. It was hit very hard by the consecutive waves during the autumn and winter of 2020–2021, which resulted in one of the, if not the highest rates of COVID-19 mortality per capita in the world (304.33 deaths/100,000) [2]

Methods

Results

Conclusion