Hemoadsorption therapy in severe covid-19 patients requiring venovenous ecmo: A retrospective study

ABSTRACT

Introduction: Patients with severe COVID-19 may develop sepsis-like syndrome that can progress to multiple organ failure and ultimately death. Underlying mechanism have been explored and suggest a profound dysregulation of the immune system associated with hyperinflammation, hemodynamic instability and respiratory failure. Approaches modulating the dysregulated immune response, such as CytoSorb hemoadsorption, have been used. However, data of ECMO-dependent patients in comparison to a control cohort remain scarce. Patients and methods: Included were 26 critically ill COVID-19 patients requiring high-flow veno-venous extracorporeal membrane oxygenation (VV ECMO) therapy due to severe ARDS, of whom 16 were additionally treated with an extracorporeal hemoadsorption device, and compared to a control group of 10 patients. Assessed were levels of inflammatory markers, vasopressor requirements, as well as clinically relevant outcome variables. Results: Treatment with the applied multimodal therapy approach resulted in a stabilization in hemodynamics, a control of the hyperinflammatory response as evidenced by a significant reduction in inflammatory mediators, as well as a marked improvement in lung function. No device related adverse events were observed while treatment appeared safe and feasible. Conclusions: Treatment of critically ill COVID-19 patients with respiratory failure requiring VV ECMO support and hemoadsorption therapy led to a rapid and sustained hemodynamic stabilization, a control of inflammatory response and an improvement in oxygenation. Given these signals pointing towards a patient-oriented benefit of extracorporeal hemoadsorption therapy in those patients, future controlled, randomized studies should focus on the investigation of the appropriate timing and dosing of this promising treatment modality.