Hemoadsorption for management of Patients on Veno-venous ECMO Support
for Severe COVID-19 Acute Respiratory Distress Syndrome
Abstract
Background and aim of the study: Patients with severe coronavirus
disease 2019 (COVID-19) develop a profound cytokine-mediated
pro-inflammatory response. This study reports outcomes in 10 patients
with COVID-19 supported on veno-venous extracorporeal membrane
oxygenation (VV-ECMO) who were selected for the emergency use of a
hemoadsorption column integrated in the ECMO circuit. Materials and
Methods: Pre and post treatment, clinical data and inflammatory markers
were assessed to determine the safety and feasibility of using this
system, and to evaluate the clinical effect. Results: During
hemoadsorption, median levels of interleukin (IL)-2R, IL-6, and IL-10
decreased by 54%, 86%, and 64% respectively. Reductions in other
markers were observed for LDH (-49%), ferritin (-46%), D-dimer (-7%),
C-reactive protein (-55%), procalcitonin (-76%) and lactate (-44%).
Vasoactive-inotrope scores decreased significantly over the treatment
interval (-80%). The median hospital length of stay was 53 days (36-85)
and at 90-days post cannulation, survival was 90% which was similar to
a group of patients without the use of hemoadsorption. Conclusions:
Addition of hemoadsorption to VV-ECMO in patients with severe COVID-19
is feasible and reduces measured cytokine levels. However, in this small
series, the precise impact on the overall clinical course and survival
benefit still remains unknown.