Journal Article

Therapeutic plasma exchange in adult critically ill patients with life-threatening SARS-CoV-2 disease: A pilot study

Alodat, Mohammed, Faqihi, Fahad, Kutsogiannis, Demetrios J., Brindley, Peter G., Karakitsos, Dimitrios, Alharthy, Abdulrahman

2020

Overview

We investigated the effect of therapeutic plasma exchange (TPE) on life-threatening COVID-19; presenting as acute respiratory distress syndrome (ARDS) plus multi-system organ failure and cytokine release syndrome (CRS). We prospectively enrolled ten consecutive adult intensive care unit (ICU) subjects [7 males; median age: 51 interquartile range (IQR): 45.1–55.9 years old] with life-threatening COVID-19 infection. All had ARDS [PaO2/FiO2 ratio: 110 (IQR): 95.5–135.5], septic shock, CRS and deteriorated within 24 h of ICU admission despite fluid resuscitation, antibiotics, hydroxychloroquine, ARDS-net and prone position mechanical ventilation. All received 5–7 TPE sessions (dosed as 1.0 to 1.5 plasma volumes). All of the following significantly normalized (p < 0.05) following the TPE completion, when compared to baseline: Sequential Organ Function Assessment score, PaO2/FiO2 ratio, levels of lymphocytes, total bilirubin, lactate dehydrogenase, ferritin, C-reactive protein and interleukin-6. No adverse effects from TPE were observed. Acute kidney injury and pulmonary embolism were observed in 10% and 20% of patients, respectively. The duration of mechanical ventilation was 9 (IQR: 7 to 12) days, the ICU length of stay was 15 (IQR: 13.2 to 19.6) days and the mortality on day-28 was 10%. TPE demonstrates a potential survival benefit and low risk in life-threatening COVID-19, albeit in a small pilot study. •Life-threatening COVID-19 is defined as ARDS, sepsis, MSOF, and at least one criterion for cytokine release syndrome.•The application of plasma exchange resulted in decreased levels of inflammatory biomarkers in life-threatening COVID-19.•The application of plasma exchange resulted in improved clinical outcomes in life-threatening COVID-19.•Plasma exchange demonstrates a potential survival benefit, and low complication risk in life-threatening COVID-19.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Acute respiratory distress syndrome / Adsorption / Adult / Aged / Antibiotics / Antibodies / Apheresis / Bilirubin - blood / C-Reactive Protein - analysis / Chronic illnesses / Coronaviruses / COVID-19 / COVID-19 - complications / COVID-19 - therapy / Critical Care / Critical Illness - therapy / Cytokine release syndrome / Disease / Female / Ferritins - blood / Humans / Immunomodulators / Informed consent / Intensive care unit / Intensive Care Units / Interleukin-6 - blood / L-Lactate Dehydrogenase - blood / Life-threatening COVID-19 / Male / Middle Aged / Multiple Organ Failure - therapy / Patient Positioning / Patients / Pilot Projects / Plasma / Plasma Exchange - methods / Prone Position / Prospective Studies / Respiration, Artificial / Respiratory Distress Syndrome - complications / Respiratory Distress Syndrome - therapy / Sepsis / Severe acute respiratory syndrome coronavirus 2 / Statistical analysis / Therapeutic plasma exchange / Treatment Outcome / Ventilators