ICU of the Emergency Cardiology Department, National Medical Research Center of Cardiology
- 1. COVID-19 in Russia
Until 2020.6.22, there are 592280 confirmed cases of COVID-19, and 8206 death. The ICU of the Emergency Cardiology Department, National Medical Research Center of Cardiology, Moscow, Russia has been working on COVID-19 for 2 months. 82 patients were admitted, 1/3 patients were with severe cardiac comorbidities – STEMI, acute HF, takotsubo syndrome etc. The extubation rate is 43%. Weaning from NIV rate is 53%. The all-cause mortality is 15%. Eight patients recieved extracorporeal hemopurification
- Local cytokine release syndrome treatment protocol
1) The definition of COVID-associated cytokine release syndrome (CRS) is:
- Laboratory signs of hypercytokinemia, at least 2: elevated IL-6, C-RP, LDH, D-dimer, WBC, ferritin, decreased lymphocyte count.
- Acute respiratory failure: (Dyspnea, RR>24, SpO2<90%, respiratory distress)
- Proven or suspected COVID-19
2) The local CRS treatment protocol:
HA330 (Jafron, China) were used for hemoperfusion treatment, Evaclio 2C (Kawasumi, Japan) were used for plasma filtration.
- Experience of hemoperfusion
1) Selection criteria and assessment of benefits
- Inclusion criteria: Severe COVID-19-associated CRS or if IL antagonists are inefficient or unavailable with/without AKI
- Exclusion criteria: Uncontrolled unstable hemodynamic, active bleeding
- Assessment of an effect: Laboratory parameters before and after the procedure (in 2 h or in morning analyses): IL-6, C-RP, ferritin, LDH, D-dimer, WBC, lymphocyte count, ALT, AST, creatinine, bilirubin, urea
Clinical features: level of respiratory support, P/F ratio, SOFA scale, vasopressor requirement
2) Case information
Among the 8 patients received treatment, 4 were successfully release, while 4 patients died. The survived patients are generally younger with less comorbidity, and they were treated earlier from CRS.
The detail of case 1 was shared. It is a 59-year-old male. He has fever of 38.9°С (102°F), severe dyspnea, viral pneumonia (CT: 75% lung damage) before admitted to the ICU. Her clinical status is as below:
The initial treatment includes Respiratory support and Medication (Hydroxychloroquine, ritonavir/lopinavir, azithromicine, amoxycillin/clavulanic acid, sodium enoxaparin (160 mg/day), dexamethasone IV (12 mg/day). Then he received selective plasma filtration and Hemoperfusion treatment. The parameter of HP is:
- Devices: HA330 + GEMMA
- Duration: 4 h
- Blood flow rate: 100-150 ml/min
The dynamics of the patient’s clinical parameters are as below. It shows that after the HP treatment, the IL-6, CRP, and AST were all improved.
- Hemoperfusion is an effective treatment modality and it should be performed in patients with severe COVID-19 and CRS
- Combination of cytokine hemoperfusion with selective plasma filtration has advantages, providing more intensive cytokine removal in severe COVID-19, additional endotoxin removal in bacterial co-infection and metabolite removal in kidney and liver failure
- Early initiation of hemopurification can provide more benefits than when it used as a salvage therapy
- Procedure-related complications were not seen