Extracorporeal organ support in COVID-19 patients: Expert review and recommendation

In a recent review published in the journal Blood Purification, an expert panel consisting of Claudio Ronco, Sean M. Bagshaw, Rinaldo Bellomo, William R. Clark, Faeq Husain-Syed, John A. Kellum, Zaccaria Ricci, Thomas Rimmelé, Thiago Reis and Marlies Ostermann, discusses the use of extracorporeal blood purification and organ support in the critically ill patient affected by COVID-19. The panel provides an expert review and recommendation.

Concerning Polymyxin B hemoperfusion (Toraymyxin®), the authors write:

“In case of COVID-19 infection and CRS, with suspected or confirmed superimposed Gram-negative bacterial infections, the use of PMX-HP is indicated in the early phases to provide endotoxin adsorption. PMX-HP should be used for 2 subsequent days. If CRS is present, this treatment should be followed by methods for cytokine adsorption […], and if organ support is required, CRRT should be implemented in conjunction or afterward. Such treatment of endotoxin removal, cytokine removal, and organ support along the course of the ICU stay is referred to as sequential extracorporeal therapy. Thus, ECOS represents the perfect combination of techniques to provide blood purification in COVID-19 patients”.

In their practical recommendation for critically ill COVID-19 patients, the authors write the following concerning Polymyxin B hemoperfusion (Toraymyxin®):

“In the future, genetic profiling may guide the initiation of this therapeutic strategy for specific patients. If PMX-HP is indicated for suspected sepsis (high procalcitonin and/or positive bacterial culture) or confirmed by elevated endotoxin activity assay, 2-h sessions in 2 subsequent days are advised. A third session might be required in some patients”.

The article is available here.

Blood Purif, 2020 May 26;1-11