Plasma Exchange: An Effective Rescue Therapy in Critically Ill Patients With Coronavirus Disease 2019 Infection

Fernández, Javier; Gratacós‐Ginès, Jordi; Olivas, Pol; Costa, Montserrat; Nieto, Susana; Mateo, Dolors; Sánchez, María Belén; Aguilar, Ferrán; Bassegoda, Octavi; Ruíz, Pablo; Caballol, Berta; Pocurull, Anna; Llach, Joan; Mustieles, María Jesús; Cid, Joan; Reverter, Enric; Toapanta, Néstor; Hernández-Tejero, María; Martínez, José Antonio; Clària, Joan; Fernández, Carlos; Mensa, José; Arroyo, Vicente; Castro, Pedro; Lozano, Miquel

doi:10.1097/ccm.0000000000004613

Cited by 43 publications

(84 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Increasing publications of case series and case reports from centers across the world have now described the efficacy of TPE in over 60 COVID-19 patients that did not respond to initial therapies, with the majority having been treated with corticosteroids. 185 -195 Nearly all describe similar positive physiologic and clinical responses temporally associated with initiation or completion of TPE. Further, 3 retrospective, observational cohort studies including a total of 74 patients treated with plasmapheresis have reported dramatic differences in both extubation and survival.…”

Section: Methylprednisolone and Covid-19mentioning

confidence: 99%

RETRACTED: Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19

Kory

Meduri

Iglesias

et al. 2020

J Intensive Care Med

View full text Add to dashboard Cite

In December 2019, COVID-19, a severe respiratory illness caused by the new coronavirus SARS-CoV-2 (COVID-19) emerged in Wuhan, China. The greatest impact that COVID-19 had was on intensive care units (ICUs), given that approximately 20% of hospitalized cases developed acute respiratory failure (ARF) requiring ICU admission. Based on the assumption that COVID-19 represented a viral pneumonia and no anti-coronaviral therapy existed, nearly all national and international health care societies’ recommended “supportive care only” avoiding other therapies outside of randomized controlled trials, with a specific prohibition against the use of corticosteroids in treatment. However, early studies of COVID-19-associated ARF reported inexplicably high mortality rates, with frequent prolonged durations of mechanical ventilation (MV), even from centers expert in such supportive care strategies. These reports led the authors to form a clinical expert panel called the Front-Line COVID-19 Critical Care Alliance (www.flccc.net ). The panel collaboratively reviewed the emerging clinical, radiographic, and pathological reports of COVID-19 while initiating multiple discussions among a wide clinical network of front-line clinical ICU experts from initial outbreak areas in China, Italy, and New York. Based on the shared early impressions of “ what was working and what wasn’t working,” the increasing medical journal publications and the rapidly accumulating personal clinical experiences with COVID-19 patients, a treatment protocol was created for the hospitalized patients based on the core therapies of methylprednisolone, ascorbic acid, thiamine, heparin and co-interventions (MATH+). This manuscript reviews the scientific and clinical rationale behind MATH+ based on published in-vitro, pre-clinical, and clinical data in support of each medicine, with a special emphasis of studies supporting their use in the treatment of patients with viral syndromes and COVID-19 specifically. The review concludes with a comparison of published multi-national mortality data with MATH+ center outcomes.

show abstract

Section: Methylprednisolone and Covid-19mentioning

confidence: 99%

RETRACTED: Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19

Kory

Meduri

Iglesias

et al. 2020

J Intensive Care Med

View full text Add to dashboard Cite

show abstract

“…The patient was successfully weaned off mechanical ventilation but remained hospitalized. Fernandez et al 36 provided TPE to one COVID‐19 patient with pneumonia and APS, who then became stable for discharge. A number of neurologic conditions have been suspected to be associated with COVID‐19.…”

Section: Covid‐19 and Therapeutic Plasma Exchangementioning

confidence: 99%

The use of therapeutic plasma exchange as adjunctive therapy in the treatment of coronavirus disease 2019: A critical appraisal of the current evidence

Kelley

Fang

et al. 2021

J of Clinical Apheresis

View full text Add to dashboard Cite

The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has led to a major pandemic. While vaccine development moves forward, optimal treatment continues to be explored. Efforts include an ever‐expanding number of clinical trials along with newly proposed experimental and off‐label investigational therapies; one of which is therapeutic plasma exchange (TPE). There have been a number of publications on TPE use as adjunctive therapy for coronavirus disease 2019 (COVID‐19), but no prospective randomized controlled trials (RCTs) have been completed. This article critically appraises the current available evidence on TPE as a treatment modality for SARS‐CoV‐2 infection.

show abstract

“…In first case series plasma exchange was used to attenuate circulating cytokines and inflammatory mediators in critically ill patients with COVID-19. Case series from Barcelona and Heidelberg describe favorable effects on parameters of inflammation and clinical outcome[9, 10]. In a cohort in Oman, 11 critically ill patients underwent plasma exchange.…”

Section: Brief Reportmentioning

confidence: 99%

Generation of Inhibitory Autoantibodies to ADAMTS13 in Coronavirus Disease 2019

Doevelaar

Bachmann

Hoelzer

et al. 2021

Preprint

View full text Add to dashboard Cite

ObjectivesIt has recently been shown that von Willebrand factor (vWf) multimers may be a key driver of immunothrombosis in Coronavirus disease 2019 (COVID-19). Since COVID-19 is associated with an increased risk of autoreactivity, the present study investigates, whether the generation of autoantibodies to ADAMTS13 contributes to this finding.DesignObservational prospective controlled multicenter study.SettingBlood samples and clinical data of patients with COVID-19 were collected regularly during hospitalization in the period from April to November 2020.Patients90 patients with confirmed COVID-19 of mild to critical severity and 30 healthy controls participated in this study.Measuerements and Main ResultsAntibodies to ADAMTS13 occurred in 31 (34.4%) patients with COVID-19. Generation of ADAMTS13 antibodies was associated with a significantly lower ADAMTS13 activity (56.5%, interquartile range (IQR) 21.25 vs. 71.5%, IQR 24.25, p=0.0041), increased disease severity (severe or critical disease in 90% vs. 62.3%, p=0.0189), and a trend to a higher mortality (35.5% vs. 18.6%, p=0.0773). Median time to antibody development was 11 days after first positive SARS-CoV-2-PCR specimen.ConclusionThe present study demonstrates for the first time, that generation of antibodies to ADAMTS13 is a frequent finding in COVID-19. Generation of these antibodies is associated with a lower ADAMTS13 activity and an increased risk of an adverse course of the disease suggesting an inhibitory effect on the protease. These findings provide a rationale to include ADAMTS13 antibodies in the diagnostic workup of SARS-CoV-2 infections.

show abstract

Plasma Exchange: An Effective Rescue Therapy in Critically Ill Patients With Coronavirus Disease 2019 Infection

Abstract: Supplemental Digital Content is available in the text.

Cited by 43 publications

References 14 publications

RETRACTED: Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19

RETRACTED: Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19

The use of therapeutic plasma exchange as adjunctive therapy in the treatment of coronavirus disease 2019: A critical appraisal of the current evidence

Generation of Inhibitory Autoantibodies to ADAMTS13 in Coronavirus Disease 2019

Contact Info

Product

Resources

About