Доклад Эрика Аветисяна, врача-кардиолога Отдела неотложной кардиологии ФГБУ «НМИЦ кардиологии» Минздрава России, в рамках вебинара Jafron «Гемосорбция у пациентов с тяжелым течением коронавирусной инфекции COVID-19»

Erik Avetisyan

ICU of the Emergency Cardiology Department, National Medical Research Center of Cardiology
Moscow, Russia

  1. 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
  2. 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.

  1. 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.

Доклад Эрика Аветисяна, врача-кардиолога Отдела неотложной кардиологии ФГБУ "НМИЦ кардиологии" Минздрава России, в рамках вебинара Jafron «Гемосорбция у пациентов с тяжелым течением коронавирусной инфекции COVID-19»

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.

Доклад Эрика Аветисяна, врача-кардиолога Отдела неотложной кардиологии ФГБУ "НМИЦ кардиологии" Минздрава России, в рамках вебинара Jafron «Гемосорбция у пациентов с тяжелым течением коронавирусной инфекции COVID-19»

Доклад Эрика Аветисяна, врача-кардиолога Отдела неотложной кардиологии ФГБУ "НМИЦ кардиологии" Минздрава России, в рамках вебинара Jafron «Гемосорбция у пациентов с тяжелым течением коронавирусной инфекции COVID-19»

Доклад Эрика Аветисяна, врача-кардиолога Отдела неотложной кардиологии ФГБУ "НМИЦ кардиологии" Минздрава России, в рамках вебинара Jafron «Гемосорбция у пациентов с тяжелым течением коронавирусной инфекции COVID-19»

3) Conclusion

  • 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