Hemoperfusion in a COVID-19 Patient With Severe Burn Injuries

ABSTRACT

Introduction: Severe burn injury can cause effects in cellular mechanisms known as systemic inflammatory response syndrome. Survival rate is decreased in patients with severe burns with the added insult of this inflammatory response. Optimizing management for these patients can include utilization of hemoperfusion to decrease inflammatory reposnse and mortality rate. The use of hemoperfusion is not usually included in the initial treatment but few studies showed promising benefits. Case Description A 29-year old male who works in smelting industry, had a flame burn injury. Upon arrival in the ER, COVID-19 RT PCR oral and nasopharyngeal swab turned out to be positive, and he was transferred to a COVID critical care unit. Altogether there was ~67% TBSA affected. Fluid resuscitation was started with saline alternating with Lactated Ringer's solution. Surgeries were done sequentially. There was a high inflammatory state on the 2nd hospital day as shown by high-grade fever with a temperature of 38-39oC and elevated CRP of 48 and Procalcitonin at 22.51 ng/mL. Hemoperfusion was done for three consecutive days from 2nd to 4th hospital day using HA330 cartridge. Urine output and biochemical markers eventually improved (Fig. 1). Discussion(s) Hemoperfusion is indicated to remove cytokines in patients with sepsis and systemic inflammatory response syndrome. There were several studies with conflicting evidence for the use of hemoperfusion and other forms of extracorporeal therapies in an inflammatory state. Hemoperfusion done in this case involves the use of a standard hemodialysis machine done for 3 consecutive days using the HA330 cartridge for 3 hours each session. The return of levels to baseline or normal procalcitonin plasma concentrations have a high negative predictive value to rule out severe systemic inflammation. The indication for hemoperfusion in severe burn injury patients with severe inflammatory response syndrome still remains experimental. There is no current recommendation for the use of hemoperfusion specifically on burn patients, and further clinical trials were recommended. (Figure Presented).