Extracorporeal Blood Purification and Organ Support in the Critically Ill Patient during COVID-19 Pandemic: Expert Review and Recommendation

Abstract

Critically ill COVID-19 patients are generally admitted to the ICU for respiratory insufficiency which can evolve into a multiple-organ dysfunction syndrome requiring extracorporeal organ support. Ongoing advances in technology and science and progress in information technology support the development of integrated multi-organ support platforms for personalized treatment according to the changing needs of the patient. Based on pathophysiological derangements observed in COVID-19 patients, a rationale emerges for sequential extracorporeal therapies designed to remove inflammatory mediators and support different organ systems. In the absence of vaccines or direct therapy for COVID-19, extracorporeal therapies could represent an option to prevent organ failure and improve survival. The enormous demand in care for COVID-19 patients requires an immediate response from the scientific community. Thus, a detailed review of the available technology is provided by experts followed by a series of recommendation based on current experience and opinions, while waiting for generation of robust evidence from trials.

Immunomodulation for Severe COVID-19 Pneumonia: The State of the Art

“…Several studies have shown the attractive effects of blood purification treatment in relieving cytokine storms and improving the outcomes for patients critically ill with COVID-19 ( 61 – 63 ). Importantly, better efficacy can be achieved with earlier application of blood purification therapies ( 64 – 66 ). Blood purification has been recommended by consensus of Chinese experts for the treatment of patients with severe COVID-19 ( 51 , 67 ).…”

Blood purification therapy with a hemodiafilter featuring enhanced adsorptive properties for cytokine removal in patients presenting COVID-19: a pilot study

“…From a patient-management prospective, early reports on COVID-19 have documented the need for renal replacement therapy (RRT) in approximately 23-36% of patients [4;6] (vs 10% in the ICU general population [15]), ensuing after a median of 15 days after illness onset [1,2,5]. Also, 67% of these present additional multiple organ failure, suggesting a relevant role for organ support and cytokine blockade/removal [16]. Despite the efficacy of extracorporeal blood purification therapies (EBP) applied in hyper-inflammatory states have still not been established and their mechanisms are still the object of research, some authors have proposed RRT in combination with sequential EBP as a means to support renal function and attenuating systemic inflammation in COVID-19 [11].…”

High-dose CytoSorb hemoadsorption is associated with improved survival in patients with septic shock: A retrospective cohort study

“…Such hyperin ammatory state can lead to impairment or destruction of the lungs and other organs. As an extreme increase in various proand anti-in ammatory cytokines such as IL-1, IL-2, IL-7, IL-10, G-CSF, MCP-1, MIP-1α, INF-γ and TNF-α [41] has been postulated some authors have advocated for the use of hemoadsorption in treating COVID-19associated cytokine storm syndrome [56][57][58][59]. As a consequence, in April 2020, the CytoSorb® was temporarily approved by the U.S. Food and Drug Administration (FDA) for emergency use in patients with CRS under certain conditions [60].…”