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Hemoadsorption for management of Patients on Veno-venous ECMO Support for Severe COVID-19 Acute Respiratory Distress Syndrome
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  • Travis Geraci,
  • Zachary Kon,
  • Nader Moazami,
  • Stephanie Chang,
  • Julius Carillo,
  • Stacey Chen,
  • Anthony Fargnoli,
  • Marjan Alimi,
  • Harvey Pass,
  • Aubrey Galloway,
  • Deane Smith
Travis Geraci
New York University Medical Center
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Zachary Kon
NYU Langone Health
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Nader Moazami
NYU Langone Health
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Stephanie Chang
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Julius Carillo
NYU Langone Health
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Stacey Chen
NYU Langone Health
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Anthony Fargnoli
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Marjan Alimi
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Harvey Pass
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Aubrey Galloway
NYU Langone Health
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Deane Smith
NYU Langone Health
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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.

Peer review status:ACCEPTED

15 Mar 2021Submitted to Journal of Cardiac Surgery
18 Mar 2021Assigned to Editor
18 Mar 2021Submission Checks Completed
20 Apr 2021Reviewer(s) Assigned
01 May 2021Review(s) Completed, Editorial Evaluation Pending
01 May 2021Editorial Decision: Accept