EXTRACORPOREAL BLOOD PURIFICATION IN COVID-19 WITH SERAPH 100 MICROAFFINITY BLOOD FILTER: A SINGLE-CENTER CASE SERIES

ABSTRACT

TOPIC Critical Care TYPE Fellow Case Reports INTRODUCTION: The SARS-Cov-2 (COVID-19) pandemic has had a significant impact on healthcare and the economy worldwide. In a subset of patients, COVID-19 causes a cytokine-mediated systemic hyperinflammatory response, often resulting in acute respiratory distress syndrome (ARDS) as well as multi-organ dysfunctions. Due to the hyperinflammatory response, the Seraph 100 Microbind Affinity Blood Filter has obtained Emergency Use Authorization (EUA) from the Food and Drug Administration (FDA). The Seraph 100 filter is an extracoporeal hemoperfusion device designed to remove pathogens directly from the blood via heparin-coated polyethylene beads. It is conjectured and shown in vitro to assist in the treatment of COVID-19 organ dysfunction by reducing the burden of viremia as well as circulating cytokines within the bloodstream. CASE PRESENTATION In this case series, we present four patients admitted with severe COVID-19 who were treated with the Seraph 100 filter under the EUA. Variables assessed included the mean arterial pressure, heart rate, oxygen saturation, temperature, lactate, and pH along with vasopressor requirements before, during, and after Seraph filter use. At the time of treatment initiation with the Seraph 100 filter, all four patients met criteria for septic shock and three of the four patients had bacteremia with Staphylococcus aureus. Two of our patients (survivors) had a significant reduction in vasopressor requirement in the first few hours of treatment despite a minimal change in patients' acid-base status. The survivors also demonstrated improvements in their oxygen saturation and oxygen requirements and were ultimately discharged from the hospital. The remaining two patients (non-survivors) did not have a change in vasopressor requirement or oxygenation after one treatment with the Seraph 100 filter. One of these patient's treatments was terminated prematurely due to clinical decline and reconsideration of the patient's goals of care with family. Both of these patients passed away. DISCUSSION: We present four cases with various outcomes of critical illness related to COVID-19 treated with the novel Seraph 100 filter. Two of the four patients treated with the Seraph 100 had significant and dramatic clinical improvement upon initiation of treatment and were weaned off vasopressor support within 48 hours. Unfortunately, the other two patients showed no clinical improvement and subsequently declined resulting in death during hospitalization. The two survivors had a shorter duration of vasopressor-dependent shock prior to treatment with the Seraph 100 than the non-survivors. CONCLUSIONS: In conclusion, the Seraph 100 may improve hemodynamics in patients with COVID-19 and secondary infections. Future studies with a larger cohort will help select appropriate patients as well as determine optimal timing for initiation of therapy. REFERENCE #1 Seffer, MT, Cottam, D, Forni LG, Kielstein, JT. Heparin 2.0 A New Approach to the Infection Crisis. Blood Purification. 2021;50(1)28-34. REFERENCE #2 "ExThera Medical MedTech Company Developing Blood Filters That Can Capture a Wide Range of Pathogens." ExThera Medical V, www.extheramedical.com/. REFERENCE #3 Ronco, C, et al. Extracorporeal Blood Purification and Organ Support in the Critically Ill Patient during COVID-19 Pandemic Expert Review and Recommendations. Blood Purification. 2021;5017-27. DISCLOSURES No relevant relationships by Rohini Chatterjee, source=Web Response No relevant relationships by Mateo Houle, source=Web Response No relevant relationships by John Hunninghake, source=Web Response No relevant relationships by Arjun Kalra, source=Web Response No relevant relationships by Ian McInnis, source=Web Response No relevant relationships by Mai Nguyen, source=Web Response No relevant relationships by Nicholas Niazi, source=Web Response No relevant relationships by Melissa Rosas, source=Web Response No relevant relationships by Lauren Sattler, source=Web Response No relevant relationships by Michal Sobieszczyk, source=Web Response No relevant relationships by Brandon Walker, source=Web Response No relevant relationships by Robert Walter, source=Web Response