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\begin{document}

\title{Cytokine Filter Application in COVID-19 Patients; Island of Hope for
Crash and Burn Patients or Future Solution for All Septic Acute
Respiratory Distress Syndrome (ARDS) Patients}



\author[1]{Ali Ghodsizad}%
\affil[1]{University of Miami}%


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  \date{May 05, 2024}


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\textbf{Cytokine Filter Application in COVID-19 Patients; Island of Hope
for Crash and Burn Patients or Future Solution for All Septic Acute
Respiratory Distress Syndrome (ARDS) Patients}

Ali Ghodsizad MD, PhD, FACC, FETCS, FACS

The COVID-19 pandemic crisis certainly has challenged the scientific
community as well as entire world. While incidence numbers have
decreased following expedited vaccination and precautions, still some
patients present with COVID 19 related pneumonia and ARDS requiring
Veno-Venous Extracorporeal Membrane Oxygenation (VV ECMO) support to
survive.

In COVID-19 patients a cytokine release syndrome concomitant with ARDS
can lead to overwhelming clinical scenario. Geraci and colleagues report
on their single center feasibility study looking at application of the
Cytosorb\textsuperscript{TM} hemadsorption device which was used as a
parallel circuit within the VV ECMO circuit.

The authors give evidence for safety and feasibility of the
Cytosorb\textsuperscript{TM} hemadsorption device use in 10 patients
with COVID-19 related ARDS in combination with VV ECMO. They show a
reduction of inflammatory markers and cytokines following hemadsorption
treatment. The cytokine storm can cause a critical clinical picture of
septic shock. Only under high vasopressor and inotropic support end
organ perfusion can be maintained. The required invasive pressure
ventilation with high PEEP and peak pressure can decrease the
intrathoracic venous return further and contributes more to the shock
physiology (1). We have to look at inspiring results from current single
center experience carefully understanding the evolving nature of
COVID-19 related ARDS. Other groups have used plasmapheresis and CVVH
modifications in COVID-19 cases. Dominik et al have shown a significant
benefit only using hemadsorption comparing to other used protocols (2).

We have shown successful application of somatic stem cells in COVID-19
patients on VV ECMO at our center. We could observe a reduction of
inflammatory markers following somatic stem cell application (3). COVID
19 ARDS patients who required VV ECMO support, underwent a Pulmonary
Artery (PA)-catheter placement and allogenic human stem cell injection
into the PA using the PA-catheter as part of our expanded access
protocol (3,4).

Brouwer and colleagues, another group working with hemadsorption, have
actually shown reduced survival in patients undergoing hemadsorption
therapy (5). Geraci and colleagues describe their overall VV ECMO
survival for COVID 19 related respiratory failure to be \textgreater{}
90\%. Others including our center have experienced a much lower survival
in that patient population. So patient selection clearly is a key point.
The results presented by Geraci and colleagues have to be taken as a
pioneering step, which can help in ARDS and septic clinical scenarios
with different pathology in future.

\textbf{References:}

Grant AA et al, A Weaning Protocol for Venovenous Extracorporeal
Membrane Oxygenation With a Review of the Literature.

Artif Organs. 2018 Jun;42(6):605-610

\begin{enumerate}
\tightlist
\item
  Dominik et al, Similarities,~Differences, and Potential Synergies in
  the Mechanism of Action of Albumin Dialysis Using the MARS Albumin
  Dialysis Device and the CytoSorb~Hemoperfusion~Device in the Treatment
  of Liver Failure. Blood Purif. 2021;50(1):119-128. doi:
  10.1159/000508810. Epub 2020 Jul 2.
\item
  Kaushal et al, Intravenous mesenchymal stem cells in ECMO patients
  with severe COVID 19 ARDS, Med R\textsubscript{X} IV, 2020
\item
  A Ghodsizad et al, Transplanted human cord blood-derived unrestricted
  somatic stem cells improve left-ventricular function and prevent
  left-ventricular dilation and scar formation after acute myocardial
  infarction. Heart. 2009 Jan;95(1):27-35. doi: 10.1136/hrt.2007.139329.
  Epub 2008 Jun 2
\item
  Brouwer et al, Hemoadsorption with CytoSorb shows a decreased observed
  versus expected 28-day all-cause mortality in ICU patients with septic
  shock: a propensity-score-weighted retrospective study. Critical Care.
  2019 Sep 18;23(1):317.
\end{enumerate}

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