key: cord-0063696-lmvbhp3p
authors: Damiani, Marianna; Gandini, Lucia; Landi, Francesco; Borleri, Gianmaria; Fabretti, Fabrizio; Gritti, Giuseppe; Riva, Ivano
title: Extracorporeal Cytokine Hemadsorption in Severe COVID-19 Respiratory Failure
date: 2021-05-26
journal: Respir Med
DOI: 10.1016/j.rmed.2021.106477
sha: 755a047914c5f358699ae83dafb2087f78eb0bbc
doc_id: 63696
cord_uid: lmvbhp3p

nan

To the Editor, At least 20% of coronavirus disease 2019 (COVID-19) patients develop acute hypoxemic respiratory failure requiring admission to intensive care unit (ICU) in 5-32% of the cases. 1 Hyperinflammatory activation characterized by immune cell infiltration and elevated levels of cytokines as interleukin (IL)-6, IL-8, IL-10, IP-10 and PTX3 was reported as the main mechanism leading to critical illness and severe acute respiratory distress syndrome (ARDS). 2,3 Thus, reducing proinflammatory cytokines may represent a promising therapeutic strategy.

A treatment able to reduce circulating cytokines in critically ill patients is CytoSorb® A double lumen venous catheter was inserted and CytoSorb® cartridge was used with continuous veno-venous hemodiafiltration (CVVHDF) circuit with Regional Citrate Anticoagulation (RCA), to allow a longer duration of the adsorber. Ultraflux AV1000S (Fresenius) filter was used. The CVVHDF was applied at the dose of 35 ml/kg/h with interquartile range of 32-39 and blood flow rate was 100-150 ml/min. Cytosorb® adsorber was changed every 24 hours. Two patients were treated with one 24-hour cycle, while the remaining 9 were treated for 48 hours.

No unexpected adverse event was observed with CytoSorb® use. After a median follow-up of 16 days (range 6-30 days), 2 patients died (18%) after 6 and 16 days from enrolment, and 9 survived.

In 3 patients weaning was completed with extubation at day 14, 15 and 27 from enrollment. Six patients required percutaneous tracheostomy to achieve respiratory weaning. All 9 patients were , median level (bars) and interquartile range of serum cytokines before (enrolment) and after (post, after 24 hours and after 7 days) treatment with CytoSorb®. Statistical significance is referred to baseline level, comparison between the timepoints"enrolment" and "after 7 days" was done only for the 7 patients with available samples. (G-H) Daily median serum level and interquartile ranges of CRP and PaO 2 /FiO 2 ratio for the first 15 days after enrolment (Day 0 to 14). Dotted rectangle indicates treatment period. A statistical significance difference from pre-treatment values (Day 0) is present from Day 3 to Day 14 for both parameters. Legend: IL: interleukin; TNF: tumour necrosis factor; CRP: C-reactive protein.

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This work was supported in part by an unrestricted grant from Aferetica srl, Italy. We would like to thank Dr. Andjela Kurevija (Aferetica srl) for the statistical support.J o u r n a l P r e -p r o o f