Therapeutic plasma exchange in a critically ill Covid‐19 patient

Altmayer, Victor; Saheb, Samir; Rohaut, Benjamin; Marois, Clémence; Cao, Albert; Guennec, Loïc Le; Weiss, Nicolas; Demeret, Sophie

doi:10.1002/jca.21830

Cited by 10 publications

(24 citation statements)

References 11 publications

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“…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

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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.

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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

“…Thirteen of the 16 were extubated and discharged while three failed to respond and later died. 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 [250][251][252][253][254][255][256][257][258][259][260][261]. Nearly all describe similar positive physiologic and clinical responses temporally associated with initiation or completion of TPE.…”

Section: Salvage Therapymentioning

confidence: 99%

“MATH+” Multi-Modal Hospital Treatment Protocol for COVID-19 Infection: Clinical and Scientific Rationale

Kory¹,

Meduri

Iglesias

et al. 2022

J Clin Med Res

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In December 2019, coronavirus disease 2019 (COVID-19), a severe respiratory illness caused by the new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 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 non-antiviral 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.

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“…Therapeutic plasma exchange has been used to treat COVID‐19 patients who had various degrees of respiratory involvement ranging from nonintubated patients with pneumonia 22 to those with ARDS 15,31‐33 required to be in the intensive care unit (ICU) 19 . Patients reportedly demonstrated clinical improvement after TPE 15,22 .…”

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

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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.

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Therapeutic plasma exchange in a critically ill Covid‐19 patient

Cited by 10 publications

References 11 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

“MATH+” Multi-Modal Hospital Treatment Protocol for COVID-19 Infection: Clinical and Scientific Rationale

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

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