Efficiency and safety of plasma exchange in the treatment of severe covid-19

Objective. To study an efficacy and safety of therapeutic plasma exchange in the treatment of COVID-19. Material and methods. Efficacy and safety of plasma exchange in severe COVID-19 were retrospectively analyzed. Plasma exchange was performed within 24 hours after admission to ICU. Circulating plasma volume (70-150%) was replaced with donor fresh frozen plasma, CovRec plasma ≤300 ml and balanced crystalloid solutions ≤800 ml. Mean volume of exchange was 3000 ml (min 2000 ml, max 4000 ml). We analyzed mortality and need for mechanical ventilation in patients after plasma exchange in addition to standard therapy (main group) and in the control group (standard therapy alone). Results. Mortality in the main group was 16.67% (n=5), in the control group — 57.41% (n=31) (p=0.001). Conclusion. Plasma exchange is an effective and safe method significantly reducing mortality in patients with severe COVID-19. These data are confirmed by laboratory data. A multiple-center study of efficacy and safety of plasma exchange in the treatment of severe COVID-19 is needed. © S.S. OCHKIN, A.S. SAMOYLOV, YU.D. UDALOV, N.M. KRUGLYAKOV, G.I. BAGZHANOV.

Muscle mass index at the level Th12 vertebra as a prognostic factor for fatal outcome in the patients with pneumonia caused by SARS-CoV2

Purpose: To develop a methodology for determining the muscle mass index (MMI) at the level of Th12 based on the computed tomography of the chest;to estimate the impact of MMI on the outcome of the COVID19 patients as a prognostic factor. Material and methods: The medical data and computed tomography of the chest of 247 patients with confirmed pneumonia caused by SARS-Cov2 were used. A technique has been developed for determining MMI based on the cross-sectional area of paraspinal muscles at the level of the Th12 vertebra and the length of the thoracic spine. A correlation analysis of MMI calculated based on the length of the thoracic spine MMI(L) and height MMI(H) was performed. A statistical analysis of the differences of the MMI(L) in the groups of male and female patients with fatal outcome and recovered, as well as younger and older than 65 years were performed. Results: A strong correlation was found between the MMI calculated on the basis of the length of the thoracic spine and height (r = 0.861, p <0.001). The age threshold, which was associated with an increase in the likelihood of death, in men was 60 years (Se 77.3 %, Sp 60.5 %, PPV 51.5 %, NPV 83.1 %, Youden's index 0.378, area under ROC- curve 0.728), in women 65 years old (Se 72.2 %, Sp 68.6 %, PPV 49.1 %, NPV 85.5 %, Youden's index 0.408, the area under the ROC curve 0.734). The odds ratio of death when the age thresholds are exceeded was 5.2 for men (95 % CI: 2.3 - 12.0), for women - 5.7 (95 % CI: 2.4 - 13.4). MMI(L) 3.37cm2/m2 is a threshold value, below which the probability of death in male patients under 60 years increased 26.3 times (95 % CI: 4.8 - 143.0). In female patients, there was no statistically significant threshold value of MMI(L), which would be associated with a higher risk of death. Conclusion: MMI, calculated at the level Th12 on the basis of the length of the thoracic spine, can be reliably used as a tool to estimate sarcopenia associated muscle atrophy, if there is no anthropometric data. The MMI(D) less than 3.37 cm2/m2 is a strong predictor of death in men under 60 years of age. Further work is needed to study the effect of sarcopenia on the severity and outcome of COVID19 in female patients, taking into account comorbid conditions. © 2021 State Research Center, Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency. All rights reserved.

Radiation Treatment of Protective Overalls and Selection of Personal Protection Equipment for the Personnel Exposed to Coronavirus Infection

Purpose: The article covers issues related to providing personal protection equipment (PPE) for medical staff exposed to coronavirus (or similar infection) in the face of global pandemic and insufficient supply of infectious hospitals with disposable overalls. As many polymeric materials used to make such overalls do not feature required thermal stability and consequently they cannot be treated with heat disinfection, radiation treatment of protective overalls with electron accelerators for the purpose of their reuse was considered. Due to rich experience in addressing the issues of providing high-efficient, physiologically acceptable PPE for the personnel of radiation and chemical hazardous facilities, in particular during Chernobyl nuclear disaster elimination, the Laboratory of PPE for the Personnel of Hazardous Production Facilities, Burnasyan Federal Medical Biophysical Center, could extend methods of assessment and techniques of human protection against high-toxic substances to establishment of protection against microbiological threats. Results: The article provides results of analysis and tests of materials for overalls and respiratory PPE currently in use. Based on the material tests for radiation stability, air permeability, liquid penetration and protective properties with respect to aerosols, recommendations for improvement of efficiency and comfort of the PPE suite have been developed. Conclusion: The study showed feasibility of reusing overalls after radiation treatment. However, such treatment is appropriate only in periods of major emergencies during peacetime and wartime, when there are no production capabilities for manufacturing of new products. Location of the irradiation facility in the vicinity of consumers (e.g. medical institutions) is a prerequisite for this treatment. It should be emphasized that radiation treatment must be performed under strict supervision of accredited test facilities. Further research is required for development and enhancement of PPE and system of its application. This will allow to make longtime wear of PPE more comfortable without sacrificing its protective efficiency and develop a manual on product-specific radiation treatment. © 2020 State Research Center, Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency. All rights reserved.

Experience in Applying Hyperbaric Oxygen Therapy Using Portable Pressure Chambers for the Treatment of Patients with the Novel Coronavirus Infection COVID-19

This communication presents the experience of using mobile pressure chambers in patients with the confi rmed novel coronavirus infection in hospital settings. The obtained preliminary results indicate positive antihypoxic effects of hyperbaric oxygen therapy (HBO) applied in the form of increased saturation. After a session of HBO, patients demonstrated an increase in the oxygen saturation of capillary blood hemoglobin at the average level of 3.71 points. Differences between SatO2 levels prior to and following HBO treatment were signifi cant in the CT2, CT3 and CT4 groups (p0.05). As expected, the effi cacy of HBO in terms of the oxygen saturation of capillary blood hemoglobin was the greatest in the patient groups showing pronounced clinical and radiological changes in the lungs. В сообщении представлен опыт применения мобильных барокамер пациентам с подтвержденной новой коронавирусной инфекцией в стационарных условиях. Полученные первичные обнадеживающие результаты свидетельствуют о положительных антигипоксических эффектах применения гипербарической оксигенации (ГБО) в виде повышения сатурации. Средний прирост насыщения гемоглобина капиллярной крови кислородом среди наблюдаемых пациентов после сеанса ГБО составил 3,71 пункта. Различия между уровнем SatO2 до и после процедуры ГБО были достоверными в группах КТ2, КТ3 и КТ4 (p0,05). Как и можно было ожидать, эффективность процедуры ГБО в плане воздействия на показатель насыщения гемоглобина капиллярной крови кислородом оказалась наибольшей в группах лиц с выраженными клинико-рентгенологическими изменениями в лёгких.