by Fernandez, Javier; Gratacos-Ginès, Jordi; Olivas, Pol;
Costa, Montserrat; Nieto, Susana; Mateo, Dolors; Sánchez, María Belén; Aguilar,
Ferran; Bassegoda, Octavi; Ruiz, Pablo; Caballol, Berta; Pocurull, Anna; Llach,
Joan; Mustieles, María Jesús; Cid, Joan; Reverter, Enric; Toapanta, Nestor
David; Hernández-Tejero, María; Martínez, José Antonio; Claria, Joan;
Fernández, Carlos; Mensa, José; Arroyo, Vicente; Castro, Pedro; Lozano, Miquel;
for the Covid Clinic Critical Care (CCCC) Group
Objectives:
Infection by severe acute respiratory syndrome coronavirus-2
can induce uncontrolled systemic inflammation and multiple organ failure. The
aim of this study was to evaluate if plasma exchange, through the removal of
circulating mediators, can be used as rescue therapy in these patients.
Design:
Single center case series.
Setting:
Local study.
Subjects:
Four critically ill adults with coronavirus disease 19
pneumonia that failed conventional interventions.
Interventions:
Plasma exchange. Two to six sessions (1.2 plasma volumes).
Human albumin (5%) was used as the main replacement fluid. Fresh frozen plasma
and immunoglobulins were administered after each session to avoid coagulopathy
and hypogammaglobulinemia.
Measurements and Main
Results:
Serum markers of inflammation and macrophage activation. All
patients showed a dramatic reduction in inflammatory markers, including the
main cytokines, and improved severity scores after plasma exchange. All
survived to ICU admission.
Conclusions:
Plasma exchange mitigates cytokine storm, reverses organ
failure, and could improve survival in critically ill patients with coronavirus
disease 2019 infection.
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