Extracorporal hemocorrection methods for COVID-19: are there outlooks?

Abstract

Viral epidemics of various scales have ceased to be something extraordinary. However, it is unlikely that the COVID-19 epidemic can be compared to any other, except the Spanish flu epidemic of 1918-1919. The review discusses the pathogenesis of the "cytokine storm" and possible extracorporeal methods of its correction. Following the "Third International Consensus on the definition of sepsis and septic shock (Sepsis-3)", sepsis is recommended to be understood as "life-threatening acute organ dysfunction resulting from a violation of the regulation of the response of the macroorganism to infection". Severe COVID-19 is practically a variant of viral sepsis. However, the disease is not coded as sepsis and is not treated as sepsis. Great hopes are pinned on vaccination, which, presumably, should significantly reduce the likelihood of adverse outcomes. However, while the epidemiological situation is far from ideal, there are no "golden" standards of drug therapy. Therefore, do not forget about direct methods of removing proinflammatory cytokines. Among them, hemofiltration, combined hemocorrection, plasma exchange, combined plasma filtration, and adsorption are discussed. We were not able to identify the ideal method. This is probably due to the difficulties of performing randomized clinical trials among patients with severe COVID-19. The reasons are also discussed in the review.