First Reported Use of Highly Adsorptive Hemofilter in Critically Ill COVID-19 Patients in the USA

Abstract

Critically ill patients with coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) develop respiratory failure and septic shock. Extracorporeal blood purification is proposed as an adjuvant therapy for sepsis and aims at controlling the dysregulated autoimmune system. We describe our experience in treating COVID-19 patients with the oXiris ® hemofilter which adsorbs both cytokines and endotoxins, provides renal replacement therapy and has anti-thrombogenic properties. It was approved by the US Food and Drug Administration (FDA) under emergency use authorization for COVID-19 patients in April 2020. In our study, the use of the oXiris ® filter decreased levels of inflammatory markers including interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), and improved clinical outcomes in two out of three patients.

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

“…In the treatment of H7N9-induced severe pneumonia, which is also characterized by ARDS, plasma exchange (PE) combined with continuous veno-venous hemofiltration treatment can significantly reduce serum levels of cytokines and improve outcomes ( 60 ). 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 ).…”

Continuous hemodiafiltration with the oxiris filter ameliorates cytokine storm and induces rapid clinical improvement in COVID-19 – A case report

“…oXiris is a highly adsorptive membrane with unique four-in-one properties which include cytokine and endotoxin removal in vitro and in septic shock patients, renal replacement therapy, and anti-thrombogenic features. [ 7 ] It is pre-grafted with Polyethyleneimine (PEI) and an average of 4,500 UI/m 2 heparin during manufacturing, The positively charged free amino groups, in particular linear PEI grafting allows it to adsorb large negatively charged molecules, such as endotoxins and cytokines. This unique design makes the combination of renal support, cytokine removal, endotoxin removal, and local anticoagulant treatment possible in a single device, which is simple to use.…”

Acute Kidney Injury and Advanced Kidney Disease in the COVID-19 Pandemic: Proceedings From a National Kidney Foundation Symposium

“…The removal of cytokines via extracorporeal therapies has been an active area of study. 42 , 44 , 45 Extracorporeal treatments should theoretically not interfere with experimental antibody-based therapies used in COVID-19 (e.g., tocilizumab, convalescent plasma, intravenous immunoglobulins), as hemodialysis filters and hemadsorption cartridges do not remove antibodies. The size of these antibodies exceed the size of molecules that can be removed with extracorporeal treatments.…”

“…Studies indicate that certain filters can remove inflammatory markers in critically ill COVID-19 patients. 42 , 44 , 45 However, further research is necessary to explain the outcomes related to these therapies.…”