Intravenous immunoglobulin fails to improve ARDS in patients undergoing ECMO therapy

Abstract

BackgroundAcute respiratory distress syndrome (ARDS) is associated with high mortality rates. ARDS patients suffer from severe hypoxemia, and extracorporeal membrane oxygenation (ECMO) therapy may be necessary to ensure oxygenation. ARDS has various etiologies, including trauma, ischemia-reperfusion injury or infections of various origins, and the associated immunological responses may vary. To support the immunological response in this patient collective, we used intravenous IgM immunoglobulin therapy to enhance the likelihood of pulmonary recovery.MethodsARDS patients admitted to the intensive care unit (ICU) who were placed on ECMO and treated with (IVIG group; n = 29) or without (control group; n = 28) intravenous IgM-enriched immunoglobulins for 3 days in the initial stages of ARDS were analyzed retrospectively.ResultsThe baseline characteristics did not differ between the groups, although the IVIG group showed a significantly reduced oxygenation index compared to the control group. We found no differences in the length of ICU stay or ventilation parameters. We did not find a significant difference between the groups for the extent of inflammation or for overall survival.ConclusionWe conclude that administration of IgM-enriched immunoglobulins as an additional therapy did not have a beneficial effect in patients with severe ARDS requiring ECMO support.Trial registrationClinical Trials: NCT02961166; retrospectively registered.

The use of intravenous immunoglobulin gamma for the treatment of severe coronavirus disease 2019: a randomized placebo-controlled double-blind clinical trial

“…Inclusion criteria included being over 18 years of age, possessing a PCR-confirmed COVID-19 diagnosis, involvement of > than 30% of both lungs (ground-glass opacity) in high-resolution computed tomography (HRCT) (confirmed by two radiologists), O 2 saturation (satO 2 ) of < 90%, and a lack of adequate response to initial treatment including at least both one antiviral and one chloroquine-class drug. Exclusion criteria, in addition to an age of less than 18 years, included pregnancy, coagulation disorders (such as hemophilia, Von Willebrand disease, other clotting factor deficiencies), history of hypersensitivity to IVIg, advanced heart failure (defined as a left ventricular ejection fraction less than 35%), pulmonary fibrosis/history of lung surgery, and the presence of either sarcoidosis or tuberculosis (that may interfere with an accurate estimation of the severity of pulmonary interference by COVID- 19).…”

“…Coronavirus disease 2019 (COVID- 19) was declared to be a pandemic by the World Health Organization on March 11th, 2020 [1]. The culprit virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly communicable and can spread through respiratory droplets [2].…”

The use of intravenous immunoglobulin gamma for the treatment of severe coronavirus disease 2019: A randomised placebo-controlled double-blind clinical trial

“…Our results provide evidence to support the administration of IVIg for improving clinical outcomes in COVID-19 patients with severe respiratory system involvement. Prohaska et al previously conducted research to suggest that IVIg could not be used effectively to reduce the mortality of patients with the acute respiratory syndrome (ARDS) undergoing extracorporeal membrane oxygenation (ECMO) therapy [19]. In this study, patients with bacterial and/or fungal infection included 54% of patients in the IVIg treatment group and 28% of patients in the control (placebo) group [19].…”

“…Prohaska et al previously conducted research to suggest that IVIg could not be used effectively to reduce the mortality of patients with the acute respiratory syndrome (ARDS) undergoing extracorporeal membrane oxygenation (ECMO) therapy [19]. In this study, patients with bacterial and/or fungal infection included 54% of patients in the IVIg treatment group and 28% of patients in the control (placebo) group [19]. As the mechanisms under which our immune system eradicated bacterial and viral infections are not the same, the results of this study could not be generalised for those patients with a merely viral infection.…”

Intravenous Immunoglobulin Gamma for Severe Cases of Coronavirus Disease of 2019: A Randomized Placebo-Controlled Double-Blinded Clinical Trial

“…Previously, Prohaska et al showed that IVIg could not reduce the mortality of patients with ARDS undergoing extracorporeal membrane oxygenation (ECMO) therapy. In this study, patients with bacterial and fungal infection also included, and only 54% of patients in the IVIg group and 28% of patients in the control group had viral infection (13). Recently, a randomized controlled trial studied the hyperimmune IVIg (hIVIg) effect on patients with con rmed in uenza A or B infection.…”